In this post… The Brenner hypothesis Tubuloglomerular feedback & glomerulotubular balance How SGLT2i affect glomerular haemodynamics How loop diretics effect glomerular haemodynamics The importance of intraglomerular pressure At the cornerstone of contemporary treatments to delay CKD progression are agents (RAS inhibitors and SGLT2i) that reduce intraglomerular pressure. Whether or not this effect is the most important mechanism of nephroprotection is open to debate - particularly for SGLT2i. However, it is at the very least likely to be a central mechanism.

In this post… Why drinking seawater causes dehydration Why giving 0.9% NaCl can exacerbate hyponatraemia in some circumstances How much water do you have to drink to cause hyponatraemia Why most patients on furosemide should also have restricted water intake Why a “tea and toast” diet causes hyponatraemia Why limiting dietary solute intake can help in nephrogenic diabetes insipidus Physicists may still be searching for the grand unified theory of everything, but nephrologists have come pretty close to a unified theory of urine.

In this post… The paradoxical anti-diuretic effects of diuretics A general approach to nephrogenic diabetes insipidus When is a tractor not a tractor? … When it turns into a field Nephrogenic diabetes insipidus Nephrologists are often asked for advice on how to manage patients with nephrogenic diabetes insipidus (NDI). Almost always, this has been caused by current or historic lithium exposure. This is one of those referrals that invariably sends me scuttling back to review original literature, because I can never quite remember how on earth diuretics are supposed to magically transform into anti-diuretics in this context, nor the relative merits of thiazides / amiloride / acetazolamide.

In this post… What effect do loop diuretics have on renal free water clearance? Should we stop furosemide in hyponatraemia? Why do we need to restrict water intake when giving furosemide in hyponatraemia? We are mostly water and rapidly run into trouble when we become under- or over-hydrated. We could argue, therefore, that one of the kidney’s most important jobs is that of maintaining water homeostasis. It is surprising that we are able to mess around quite profoundly with this process without running into trouble more frequently than we do.