Brief Answer:
You are quite right ma'am

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. Yes ma'am, you are quite right. Both cortisol and ACTH levels are checked as baseline which is as soon as the test has to be started, and is prior to the administration of the synthetic ACTH. After this, blood is collected at 30 minutes and 60 minutes.

I hope I have explained things in a manner best understood by you ma'am. Please feel free to write back to me for any further clarifications, I would be more than happy to help.

Best wishes.

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Brief Answer:
As your level is normal, I wouldn't say it is void

Detailed Answer:
Hello once again ma'am.

For accuracy sake, I would say it is important to have a baseline (conducted at time = 0) as this would help for reference. But if at all your cortisol level (after administering the synthetic ACTH) was found to be normal, then the baseline would not really be required. Normal levels are considered to be above 18 mcg/dL, and yours is 23 mcg/dL (normal). So I do not think there should be anything to worry about.

But for reference sake, you could speak to your doctor to conduct the test again with the baseline level as well. I hope this helps ma'am, please feel free to write back to me for any further assistance, I am always here to help.

Best wishes.

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Brief Answer:
Yes it is, but your diagnosis is quite fitting

Detailed Answer:
Hi ma'am.

Yes, there is a possibility for metabolic or rather systemic conditions like systemic lupus erythematosus to cause a laboratory presentation similar to yours and also result in the aches and pains described by you. So although I would recommend testing for SLE (i.e. ANA test at first) for your satisfaction, I do have one point to put forward. If at all you did have a metabolic or systemic condition, you would not have the multiple cysts present in your kidneys.

The polycystic kidney disease is an independent diagnosis altogether ma'am, and so once this is visualised it would be the only diagnosis without raising doubt for another underlying condition. But for your sake, you could request your doctor to rule out SLE and other conditions that can cause a presentation similar to yours.

I would also like to add that all the symptoms you have mentioned are commonly seen and associated with PKD, so there is actually no doubt raised to suspect another condition. I hope you find enough information and more in my responses that would help clear your doubts. Please do not hesitate to write back to me for any further clarifications.

Best wishes.

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Brief Answer:
Possible, not metabolic, yes it is possible

Detailed Answer:
Hello once again ma'am.

My sincere apologies for the delay. Yes, it is possible that you can present with those symptoms even if the kidney function is normal, although unlikely but it is certainly possible.

No ma'am, PKD is not a metabolic condition, it is a combination of a group of conditions. From your previous query you asked me if any metabolic condition could cause your symptoms, and my reply was that some metabolic conditions can cause the same presentation, but it is unlikely that those conditions have caused your presentation as PKD has quite clearly been diagnosed.

And PKD can certainly cause anemia and lactic acid build up ma'am. I hope this helps, please feel free to write back to me for any further clarifications, I am always here to help.

Best wishes.

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Brief Answer:
I admire your will to learn, truly

Detailed Answer:
Hello once again ma'am.

I completely understand why you would want to clear this. By textbook knowledge we are made to learn and believe various facts about medicine that have been studied and researched for years together.

But in reality, practicing medicine is way different from what was given to us in the textbooks. Each individual is made in a different way, and reacts and responds to various medications, situations, circumstances in different ways. Women are not supposed to get pregnant when on their period, but there have been numerous reported cases of pregnancy while women were seeing their period; the womb was not made to support more than 3 fetuses, but we have seen cases of women carrying 9-11 fetuses in their wombs, and so on.

There are no hard and fast rules, and experience shows you that textbooks did not prepare you for the various wonders that you can see and learn from only through experience. I have personally seen at least 2 cases of PKD in which the patients have reported of symptoms although all kidney parameters were found to be normal. Although it is important to rule out any other condition that can cause such a presentation, it is not impossible for an underlying condition (although well controlled) to continue causing symptoms in the individual.

I hope I have explained things in a manner best understood by you ma'am. I tend to get a little too graphic, please forgive me if my response became a bit too lengthy and I respect your curiosity to learn more and understand your condition better, please do not ever change this. A well informed patient has won half the battle against the illness.

Best wishes.

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Brief Answer:
It was my pleasure entirely ma'am

Detailed Answer:
Hello once again ma'am.

Although the patients were directed to a nephrologist for further management, I was still the consulting physician. The nephrologist chose to treat the patient symptomatically if I remember well (vitamin B12, pain management medication, adequate hydration, i.v. fluids, anti-spasmolytics, etc.).

Yes, low CO2 levels do point towards metabolic acidosis and lactic acidosis among other conditions (Eg. Addison's disease, poisoning cases, salicylate toxicity, diarrhoea, etc.).

Metabolic acidosis is diagnosed with the help of an arterial blood gas sample which I am guessing was already done and indicated low CO2 levels and is treated with the help of bicarbonate usually administered intravenously.

As for lactic acidosis, it is diagnosed with the help of a detailed history, physical examination (oliguria, hypotension, altered mental state, etc.), and laboratory analysis (arterial blood gas sample, serum lactate levels, anion gap, etc.). Treatment includes the introduction of dicholoroacetate, sodium bicarbonate, hemodialysis, etc.

I am humbled by your kind words ma'am, as long as my patients are happy with the information and treatment I have to offer I can go to bed in peace knowing that I have been able to contribute. Please do not ever hesitate to write to me about anything, as you must know by now, I am always here to help.

God bless and best of luck.

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Brief Answer:
Request to check vitamin D levels as well

Detailed Answer:
Hello once again ma'am.

I would be more than happy to help interpret your test results, and they are:

-Possible infection or recovery from infection
-Alkaline phosphatase level is mildly low which could indicate an abnormality with the liver or the bones. As your liver function is more or less normal, I would recommend a serum vitamin D level check
-Oxygen saturation seems to be slightly low which could be due to to various causes: poor blood supply, poor diet, narrowing of blood vessels, abnormalities with the nasal septum, or even a panic or anxiety attack at times, etc.

But in my opinion, there does not seem to be anything seriously worrying from your reports. Although as mentioned earlier, I would be comfortable if you get your serum vitamin D levels checked and write back to me.

I hope and pray you enjoy nothing but good health, now and forever.

Best wishes.

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