Papers by Mohammad Tinawi
Journal of the American Society of Nephrology, Nov 1, 2023
Journal of the American Society of Nephrology, Nov 1, 2023
Archives of internal medicine research, 2022
The definition of osteoporosis in the general population according to the World Health Organizati... more The definition of osteoporosis in the general population according to the World Health Organization (WHO) is a T-score ≤-2.5, or the presence of a low trauma fracture irrespective of bone mineral density (BMD). Osteopenia is defined by the WHO as T-score between-1 to-2.5. The prevalence of osteoporosis is higher in women with and without chronic kidney disease (CKD). In patients with CKD, osteoporosis falls within the spectrum of chronic kidney disease mineral and bone disorder (CKD-MBD). Kidney Disease Improving Global Outcome (KDIGO) CKD-MBD guidelines recommend measurements of BMD in patients with stage 3 or higher CKD to assess fracture risk. Many pharmacological options exist for the treatment of osteoporosis in the general population. There are no clinical trials in patients with CKD-MBD. Recommendations are based on expert opinion and post hoc analyses of major osteoporosis trials in the general population.
Cureus, Jan 21, 2021
Metabolic alkalosis is an increase in blood pH to >7.45 due to a primary increase in serum bicarb... more Metabolic alkalosis is an increase in blood pH to >7.45 due to a primary increase in serum bicarbonate (HCO 3 −). Metabolic alkalosis results from alkali accumulation or acid loss, and it is associated with a secondary increase in carbon dioxide arterial pressure (P a CO 2). Metabolic alkalosis is a common acid-base disorder, especially in critically ill patients. The pathogenesis of chronic metabolic alkalosis includes two derangements, generation of metabolic alkalosis via gain of alkali or loss of acid and maintenance of metabolic alkalosis by increased tubular HCO 3 − reabsorption (failure of the kidneys to excrete excess alkali). Metabolic alkalosis is the most common acid-base disorder in hospitalized patients, particularly in the surgical critical care unit. Mortality increases as pH increases.
Clinical transplantation, 1997
We retrospectively studied 133 consecutive cardiac transplant patients who had lived more than 5 ... more We retrospectively studied 133 consecutive cardiac transplant patients who had lived more than 5 months post-transplantation. All patients had received a cyclosporine (CyA) based triple immunosuppressive protocol. Mean (+/- SE) duration of follow-up was 32 +/- 1.8 months (range 5-60 months). Serial mean serum creatinine significantly increased from 1.26 +/- 0.025 mg/dl at 1-2 months post-transplant to 1.4 +/- 0.05 at 3 months, 1.48 +/- 0.03 at 6 months, and 1.55 +/- 0.04 at 9 months with a subsequent plateau in serum creatinine levels up to 60 months of follow-up, at which point it had reached 1.66 +/- 0.1 mg/dl. The reciprocal creatinine (1/Cr) curve also showed a biphasic decline in renal function, with a rapid decline in the first 6 months followed by no further decline up to 60 months of follow-up. Approximately 4% of the patients at 1-2 months, 8% at 3 months, and 12-17% at 6-60 months had serum creatinine > and = 2.0 mg/dl. None of the patients developed end-stage renal dis...
Archives of Internal Medicine Research, 2020
Hypertension is commonly encountered in the course of pregnancy. It can predate or manifest durin... more Hypertension is commonly encountered in the course of pregnancy. It can predate or manifest during pregnancy. It requires prompt recognition and treatment. If left untreated, hypertension in pregnancy will lead to significant maternal and fetal morbidity and mortality. This mini-review will discuss the classification of hypertension in pregnancy, identify treatment goals, discuss preeclampsia in some detail and discuss management of these disorders based on recent guidelines. This review is intended as a quick summary and a practical guide. Extensive reviews of the subject are widely available.
The definition of osteoporosis in the general population according to the World Health Organizati... more The definition of osteoporosis in the general population according to the World Health Organization (WHO) is a T-score ≤-2.5, or the presence of a low trauma fracture irrespective of bone mineral density (BMD). Osteopenia is defined by the WHO as T-score between-1 to-2.5. The prevalence of osteoporosis is higher in women with and without chronic kidney disease (CKD). In patients with CKD, osteoporosis falls within the spectrum of chronic kidney disease mineral and bone disorder (CKD-MBD). Kidney Disease Improving Global Outcome (KDIGO) CKD-MBD guidelines recommend measurements of BMD in patients with stage 3 or higher CKD to assess fracture risk. Many pharmacological options exist for the treatment of osteoporosis in the general population. There are no clinical trials in patients with CKD-MBD. Recommendations are based on expert opinion and post hoc analyses of major osteoporosis trials in the general population.
Cardiology and Cardiovascular Medicine
The new 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines on the management of blo... more The new 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines on the management of blood pressure in chronic kidney disease (CKD) patients were published in March 2021 in Kidney International. The full issue exceeds 80 pages. The author of this article aims to provide a succinate summary of the main points of the guidelines with special emphasis on the changes introduced since the previous 2012 guidelines. These KDIGO guidelines are evidence-based, and they are graded accordingly. As with any recent hypertension guidelines, they incorporate and emphasize the results of The Systolic Blood Pressure Intervention Trial (SPRINT) published in 2015.
Cureus
Caffeine is the core ingredient in energy drinks. These drinks are commonly consumed by athletes ... more Caffeine is the core ingredient in energy drinks. These drinks are commonly consumed by athletes around the time of their workout to boost energy levels. The patient in the case presented is a 40-year-old-man who developed severe rhabdomyolysis after consuming an energy drink with high content of caffeine prior to a strenuous workout. He was successfully treated with isotonic intravenous solutions. Clinicians should be aware of the potential adverse reactions associated with the use of energy drinks.
Archives of Clinical and Biomedical Research
Cureus, 2020
Immune checkpoint inhibitors (ICIs) are novel humanized monoclonal antibodies that release the br... more Immune checkpoint inhibitors (ICIs) are novel humanized monoclonal antibodies that release the brakes on the immune system, resulting in the destruction of tumor cells. ICIs are approved for a variety of hematological and solid organ malignancies, and the list has been growing since the approval of ipilimumab in 2011. ICIs are associated with a variety of immune-related adverse events (irAEs). irAEs commonly affect the skin, the gastrointestinal (GI) tract, and the endocrine system. Acute kidney injury (AKI) due to ICIs (ICI-AKI) occurs in a minority of patients, and it is usually due to acute tubulointerstitial nephritis (ATIN). Treatment with corticosteroids is usually successful. There have been reports of electrolyte disorders due to ICIs, including hyponatremia, hypocalcemia, hypokalemia, and Fanconi syndrome. The diagnosis of electrolyte disorders requires vigilance and routine laboratory monitoring.
Clinical & Biomedical Research, 2021
Respiratory acid-base disorders are divided into respiratory acidosis (which can be acute or chro... more Respiratory acid-base disorders are divided into respiratory acidosis (which can be acute or chronic), and respiratory alkalosis (which also can be acute or chronic). The diagnosis is made after obtaining arterial blood gases (ABGs). Respiratory acidosis is also known as primary hypercapnia and is due to an increase in carbon dioxide (CO2) tension in bodily fluids. The metabolic compensation is an increase in serum bicarbonate (HCO3−), the increase is more pronounced in chronic respiratory acidosis. Oxygen administration (O2) is critical in the management of respiratory acidosis. Respiratory alkalosis or primary hypocapnia is due to a decrease in CO2 tension in bodily fluids. The metabolic compensation is a decrease in HCO3−, the decrease is more pronounced in chronic respiratory alkalosis. Rapid correction of respiratory alkalosis should be avoided, and the underlying etiology should be addressed.
Archives of Clinical and Biomedical Research
Archives of Internal Medicine Research
Archives of Internal Medicine Research
Archives of Clinical and Biomedical Research
Phosphorus in the body exists as phosphate. Phosphate is the most abundant intracellular anion an... more Phosphorus in the body exists as phosphate. Phosphate is the most abundant intracellular anion and exists mostly as organic phosphate compounds critical to cellular functions such as adenosine triphosphate (ATP). The kidneys are the main regulator of phosphate homeostasis. There are three hormonal systems responsible for phosphate homeostasis, the parathyroid hormone (PTH), Fibroblast growth factor-23 (FGF-23)/klotho, and 1,25 dihydroxyvitamin D 3 (1,25 (OH) 2 D 3 , calcitriol). Most cases of hypophosphatemia are acquired and are due to malnutrition as in alcoholism. The kidneys maintain phosphate level in the normal range; therefore, hyperphosphatemia is uncommon until glomerular filtration rate (GFR) falls below 30 ml/min. Hyperphosphatemia is common in patients on renal replacement therapy and is treated with dietary phosphate restriction, and phosphate binders.
Potassium (K+) is the predominant intracellular cation. It is essential to the function of all li... more Potassium (K+) is the predominant intracellular cation. It is essential to the function of all living cells. Intracellular K+ concentration is over 30 times its extracellular concentration. Serum K+ is dependent on it s intake, excretion, and transcellular distribution. Most of the body’s K+ is in the muscles. Aldosterone is the main regulator of K+ renal excretion. Hypokalemia (serum K+ < 3.5 mEq/l) has multiple manifestations affecting different organ systems. Careful history and basic laboratory tests are usually adequate to diagnose most cases of hypokalemia. K+ should be replaced orally whenever feasible. Intravenous K+ replacement is needed for emergency management of hypokalemia and in patients who cannot take oral potassium.
The new 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines on the management of blo... more The new 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines on the management of blood pressure in chronic kidney disease (CKD) patients were published in March 2021 in Kidney International. The full issue exceeds 80 pages. The author of this article aims to provide a succinate summary of the main points of the guidelines with special emphasis on the changes introduced since the previous 2012 guidelines. These KDIGO guidelines are evidence-based, and they are graded accordingly. As with any recent hypertension guidelines, they incorporate and emphasize the results of The Systolic Blood Pressure Intervention Trial (SPRINT) published in 2015.
Severe dysnatremias are perplexing problems in patients undergoing renal replacement therapy on a... more Severe dysnatremias are perplexing problems in patients undergoing renal replacement therapy on a chronic or acute basis. The ability to manipulate sodium concentration in the dialysate or replacement solutions is limited. Compounding dialysate or replacement fluids to alter sodium concentration could result in errors. Rapid correction of hyponatremia or hypernatremia due to equilibrium with dialysate or replacement solutions could lead to osmotic demyelination syndrome or cerebral edema respectively. Continuous renal replacement therapy is the preferred dialysis modality in patients with severe dysnatremias. In this article, we present simple formulas to determine the rate of hypotonic or hypertonic solutions needed to mitigate rapid correction of dysnatremias. These formulas can be used readily by the clinician at bedside.
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Papers by Mohammad Tinawi