Articles on what comes before.
Clinical notes, excerpts from the book Antes and short essays on preventive nephrology, longevity, and integrative functional medicine. Content originally published on the Plenya blog, mirrored here in full.
Pre-diabetes is not a phase. It is a five-year window.
An HbA1c between 5.7% and 6.4% is usually treated as a vague warning — "let's repeat it in a year." The literature is more uncomfortable: every year without action increases the probability of progression and narrows the window in which reversal is still the most likely outcome.
Lp(a): the test your father's cardiologist didn't order
One in five people has elevated lipoprotein(a). It is genetically determined, doubles or triples the risk of heart attack and aortic stenosis — and almost never appears on a checkup. Measuring it once in a lifetime changes decades of clinical decisions.
Ferritin between 30 and 100: the normality that drains women
The 'normal' stamp on a ferritin result is one of the most expensive errors in contemporary medicine. I have seen too many women pushed toward the psychiatrist with disabling fatigue — when the problem was the wrong ruler at the lab.
Coronary calcium score: the test that changes a decade
I have seen too many heart attacks arrive with a 'normal' blood panel from the previous year. The coronary calcium score is the closest thing to a time machine I have in preventive medicine — and it costs fifteen minutes.
12 tests a longevity check-up orders
ApoB, Lp(a), fasting insulin, calcium score. The basic check-up rarely includes these twelve, and they are the markers that most predict health trajectory over the next twenty years.
When "all normal" is not enough
The lab "within range" answers an important question — do you have diagnosed disease? But it does not answer the right question, which is what trajectory you are on.
What the annual checkup does not show about your heart
Half of all heart attacks happen in people with a "normal" checkup the year before. The problem is not negligence — it is that the routine exam was designed to detect obstruction, and the real disease is something else.
Fatigue at 45 is not age — it is a diagnosis no one made
"I'm tired" is, by far, the most common complaint I hear. "It's stress, it's age" is, by far, the answer I most often see patients bring back from the previous physician. Almost always it is neither — it is a clinical signal nobody investigated to the end.
Normal versus optimal — the interval the lab does not print
The reference range on a lab report was built to detect disease, not to sustain health. The distance between the two is wide, and a great deal depends on it.
Why the nephrologist sees it first — the cardio-renal-metabolic axis
Anyone trained in nephrology learns it early: the kidney is the system that warns first. The revolution of the last five years was the rest of medicine finally accepting it — and the trials of the last decade (DAPA-CKD, EMPA-KIDNEY, FIDELIO, FLOW) put the reading at the center of the table.
Content originally published on Plenya Blog. Each article here is a faithful version of the original, with canonical pointing to the source.
This content is educational and does not constitute medical prescription. Each case is unique — for individual evaluation and care, consult a physician.