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 lab clears it as normal starting at 15 ng/mL. But menstruating women with ferritin below 50 already live with real symptoms — fatigue, hair loss, dropping performance — without ever having become anemic.
Coronary calcium score: the test that changes a decade
It is a quick CT scan, no contrast, no needle, with a radiation dose comparable to a mammogram. And what it shows — or fails to show — recalibrates the next ten years of your heart.
12 tests worth every penny — and 12 that are wasted
A bloated checkup package that forgot ApoB and measured three tumor markers with no indication. It is not the exception. It is the rule of the market. Here is what to order and what to cut.
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
The most common complaint in the office is "I'm tired." The most common clinical answer is "it's stress, it's age." Almost always, it is neither — it is a signal no one 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
The biggest revolution in preventive medicine in recent years was understanding that heart, kidney, and metabolism are a single system. And that the kidney usually speaks first.
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.