urine sediment can sometimes be bland despite the presence of various intrinsic kidney diseases such as acute interstitial nephritis (AIN), proliferative lupus glomer-ulonephritis, and acute tubular injury/ne-crosis. In addition, cells and crystals observed in urine may not always b Crystalluria may appear in bland urine sediment or be associated with concomitant hematuria and leukocyturia due to the abrasive effect of crystals on renal parenchyma and uroepithelium. As noted, not all crystalluria is pathologic. However, active urine sediment, nephrolithiasis, and AKI strongly raise the possibility of pathologic crystals active sediment inactive sediment urine protein:creatinine ratio serum chemistry r/o abnormal plasma proteins mild* moderate severe ratio < 2.0 ratio 2.0-5.0 ratio > 5.0 possibly tubular glomerular glomerular functional tubular renal interstitial post renal pursue lower urinary tract or renal interstitial disease mild glomerula Bland urine sediment Since AIN is an inflammatory kidney lesion, many clinicians expect to see an active urine sediment. In fact, a bland urine sediment is mistakenly considered diagnostic of prerenal AKI
Active urinary sediment; Antiviral therapy if appropriate; Pre-renal AKI: Hemorrhage (GIB), fluid losses (excess diuresis, diarrhea from lactulose). Suspected from patient history; Low FENa, bland urine sediment; Hemorrhage: replace volume with fluids, blood products. Control bleeding. Discontinue diuretics, administer fluids if tolerated; AT . Spot urine protein and creatinine are also useful. US Looking for cystic kidneys, hydronephrosis, asymmetry, or even symmetric evidence of medical renal disease is useful
Patients with multiple myeloma can sustain tubulointerstitial and glomerular damage by various mechanisms. Suspect myeloma-related kidney disease if patients have unexplained renal insufficiency, bland urinary sediment, and/or increased nonalbumin urinary proteins. Treat myeloma and maintain euvolemia
Often associated with: HTN Mild proteinuria (< 1gm/day) and a Bland urinary sediment. Murray and Goldberg (Annals of Internal Medicine 1975), defined an elevation in serum urate concentration out. Clinical differences : Nephrotic vs Nephritic Nephrotic syndrome Nephritic syndrome Proteinuria Gross >3.5GM Moderate < 3GM Serum Albumin Reduced Normal or mild reduction Hematuria Absent or trace Bland urine sediment Marked RBC cast /dysmorphic Active urine sediment Edema Marked Moderat Transient proteinuria occurs in persons with normal renal function, bland urine sediment, and normal blood pressure. The quantitative protein excretion is less than 1 g/day. The proteinuria is not.
Autosomal dominant tubulointerstitial kidney disease (ADTKD) refers to a group of disorders with a bland urinary sediment, slowly progressive chronic kidney disease (CKD), and autosomal dominant inheritance. Due to advances in genetic diagnosis, ADTKD is becoming increasingly recognized as a cause of CKD in both children and adults. ADTKD-REN presents in childhood with mild hypotension, CKD. Myeloma-related kidney disease is rarely caused by Ig heavy chains. (See also Overview of Tubulointerstitial Diseases .) Tubulointerstitial disease and glomerular damage are the most common types of renal damage. Glomerular damage is usually the predominant mechanism. The mechanisms by which light chains damage nephrons directly are unknown Urine protein excretion greater than 500 mg/day. An active urinary sediment with persistent hematuria (five or more red blood cells per high-power field, most of which are dysmorphic) and/or cellular casts. The urine may be contaminated with vaginal blood in menstruating women or with bladder red cells with urinary tract infections grams vs. 6 doses of higher dose IV cyclophosphamide. With steroids. With azathioprine as maintenance drug. •Similar results between groups -16% vs. 20% renal failure -71% vs. 54% remission -27% vs. 29% renal flares •Careful with patient population Houssiau FA et al. Arthritis and Rheumatism 2002;46(8):2121-213 Haber, Meryl H. Urinary Sediment: A Textbook Atlas.American Society of Clinical Pathologists. Chicago, 1981. Lillian Mundt, Kirsty Shanahan, Graff's Textbook of Routine of Urinanalysis and Body Fluids, 2nd edition, Lippincott Williams & Wilkins, Philadelphia, 2011. External links. Urine Casts - different types and what they mean. - Good description of various cast forms
Urinary Sediment • Bland - Consider: Pre renal azotemia; Urinary outlet obstruction - No RBCs or WBCs • Active Sediment / Nephritic • _ Consider RPGN • Ref. Range 2/16/2013 12:02 2/23/2013 12:38 3/2/2013 12:22 • BACTERIA Latest Range: NEGATIVE NEGATIVE NEGATIVE NEGATIVE 1+ (A Sediment Bland ACTIVE Proteinuria YES > 3g/day YES < 3 g/day Hypoalbuminemia YES < 20 g/L NO Edema YES - marked MAYBE HTN NO YES Renal Failure NO YES Hyperlipidemia YES NO Lipiduria YES NO. Nephritic Syndrome - Causes Microsoft PowerPoint - antonsen Urine in General Practice.ppt In patients with prerenal azotemia, urine microscopy is usually bland or may feature an occasional hyaline cast or fine granular cast (56, 57). In patients with ATN, urine sediment analysis typically contains kidney tubular epithelial cells, granular casts, and muddy brown or cellular casts (56, 57) A bland urine sediment supports the diagnosis of diabetes, although it is not uncommon to have some microscopic hematuria with advanced diabetic nephropathy. If active urinary sediment (red cell casts or acanthocytes) or macroscopic hematuria is found Given the bland urine sediment and the clinical presentation, the cause of AKI was consistent with CRS, although one cannot rule out some component of ATN because the FeUrea was equivocal—it was above the threshold of 35% used to define prerenal azotemia. No trial data support target rates of diuresis in patients with heart failure
´ Active urinary sediment - red cells, granular casts, red cell casts ´ Variable degree of proteinuria (< 3,5 g/day) Nephrotic Syndrome ´ No inflammation ´ Bland urinary sediment - no cells, fatty or hyaline casts ´ Nephrotic range proteinuria - > 3,5 g/day) ´ Triad - proteinuria, hyperlipidemia and oedema ABC of Intravenous Fluids 72 Selected patients with active urinary sediment (Blood, Protein, Casts): z Immunology screen (ANA/C3/C4/ANCA/Anti-GBM) - acute Gn/vasculitis z Serum Igs, electrophoresis and urine electrophoresis z Urine myoglobin to conﬁ rm rhabdomyolysis z LDH, blood ﬁ lm to aid diagnosing thrombotic micro-angiopathies Diﬀ erential Diagnosis: Pre-renal vs ATN - avoid. indwelling urinary catheter, and now she has a fever and has become hypotensive. Blood cultures are positive for Serratia marcescens. The patient's length of stay is significantly lengthened as a result of this complication. 30. Speaker Notes: Slide 5 Employing indwelling urinary catheter insertion an
Active urinary sediment is characterized by the presence of white blood cell casts, red blood cell casts, and/or dysmorphic red blood cells. These features generally indicate glomerular disease. Red blood cell casts were not present in the urine of our patient, pointing away from a glomerular process, although in rare cases red blood cell casts. III Focal proliferative Hypertension, proteinuria, active urine sediment, +dsDNA, low C3/C4, rising Cr Severe, IV Diffuse proliferative aggressively treat V Membranous Heavy proteinuria, bland sediment Intermediate, treat VI Advanced sclerosing End-stage renal diseas In the small percentage of patients for whom an etiology is identified, causes may include urinary tract infection, benign prostatic hyperplasia, medical renal disease, urinary calculi, urethral.
NEPHROTIC Nephrosis: Urinary sediment: Bland Heavy proteinuria and lipiduria Few cells or casts Less often HTN Relatively preserved renal function Sunday, March 15, 2009 6. Sunday, March 15, 200 Diabetic CKD vs non-Diabetic CKD Non-DKD DKD Onset of proteinuria Rapid Gradual Progression of CKD Rapid Gradual Duration of diabetes <5 years >10 years Urinalysis Active sediment (hematuria, pyuria, casts) Bland sediment (crystals, protein, hyaline casts) Retinopathy Absent Usually presen Renal infarction occurs when the blood supply to the kidney becomes disrupted or compromised and is often a sign of systemic illness. There are many causes of decreased blood supply to the kidney. transferred to CCU for tailored therapy. Urine sediment was bland (no ATN casts no RBC casts) Renal function remains impaired despite optimizing CHF regimen. Work up of AKI should include: A. Renal Ultrasound B. Renal Biopsy C. Renal Nuclear Medicine Scan D. Upper extremity venous mapping for AV Fistula E. No additional work up neede Urinalysis, renal ultrasound, 24 hour urine protein/creatinine or spot urine protein:creatinine ratio. GN - see active sediment on UA (protein, RBCs ( dysmorphic and/or casts), proteinuria, HTN, edema. Nephrotic - see bland sediment on U/A (mostly heavy protein), heavy proteinuria (> 3.5 g/day), edema, hyperlipidemia, hypoalbuminemi
Cholesterol-embolization syndrome (CES) is a multisystemic disease with various clinical manifestations. CES is caused by embolization of cholesterol crystals (CCs) from atherosclerotic plaques located in the major arteries, and is induced mostly iatrogenically by interventional and surgical procedures; however, it may also occur spontaneously •5 stages • 1. Hyperfiltration at diagnosis (low s. creat) • 2. Microalbuminuria > 5-10 years (urine ACR) • 3. Overt proteinuria with BP & retinopathy for 2- 5 years, minimal haematuria (MSU) • 4. CKD with normal-sized kidneys (renal U/S) • 5. ESKD 18-24 months after CK
- Oliguria / edema / HTN / active urine / fever / Urine sediment Bland Pigmented granular casts U.S.Gr > 1.018 < 1.015. AKI RIFLE SCORE Class Glomerular filtration rate criteria Urine output criteria Risk Serum creatinine × Establish acute Vs chronic renal failur Acute kidney injury is a clinical problem of growing incidence in hospitalized patients. It increases the risk of poor outcomes, length of stay and the cost of hospitalization. Successful management of acute kidney injury requires early recognition and diagnosis through detailed medical history, careful physical exam, judicious use of laboratory and radiologic tests and timely renal consultation
is 24 hr urine collection vs eGFR no more accurate 3 CKD on ultrasound - small shrunken kidneys 9 vs 10-13 cm - increased cortical echogenicity 4 Bland urine, with protein NO ACTIVE SEDIMENT. Urinary sediment. Bland. Active a. Serum uric acid. Increased. Normal. 24-h urinary calcium. Low. Normal. Anti-dsDNA. Unchanged or absent. Increased. Complement. Low-normal. Low. a Active sediment: RBC >5/hpf, WBC >5/hpf in absence of infection, presence of cellular RBC or WBC casts. Assessing SLE Activity and Flare During Pregnancy Slow, progressive renal dysfunction with proteinuria and relatively bland urine sediment; Global sclerosis >90% of glomeruli; Active GN no longer observed; Treatment: Best to initiate early; Aimed at proliferative lupus nephritis; Induction 3 - 12 months: goal is to obtain renal response Acute kidney injury (AKI) occurs commonly in patients with advanced cirrhosis and negatively impacts pre- and post-transplant outcomes. Physiologic changes that occur in patients with decompensated cirrhosis with ascites, place these patients at high risk of AKI. The most common causes of AKI in cirrhosis include prerenal injury, acute tubular necrosis (ATN), and the hepatorenal syndrome (HRS.
Urine- Bland urine sediment, Eosinophiluria during the active phase, Proteinuria is usually not a prominent feature; however, nephrotic range proteinuria. Serum-Eosinophilia, Hypocomplementemia Definitive: Biops Study CIS Renal Cases flashcards from Nicole Cabalo's Kansas City University class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition
Proteinuria in lupus was defined as 24-h urine protein excretion >0.5 g/d or urinalysis protein 3+. Before ascribing proteinuria, preeclampsia and HEELP (hemolysis, elevated liver enzymes, and low platelets) syndrome had been excluded. Active urinary sediment was defined as >5 red and white blood cells per high power field and/or ≥1 cellular. Wait for 6 months inactivity of disease (Scr <0.7mg/dl, proteinuria <0.5g/d, bland urine) SLE cont'd 25-50% fetal loss when conception occurs during active disease and Scr >1.2mg/d Adult Polycystic Kidney Disease (ADPCKD) Clinical definition. an inherited disorder that results in expansion of multiple renal cysts which ultimately leads to end-stage renal disease. Epidemiology. incidence. the most common inherited cause of kidney disease. demographics. ≥ 30 years of age In addition, bland urine sediment is not infrequent in the setting of AIN. Thus, a renal biopsy may be required to make a firm diagnosis and ensure appropriate therapeutic intervention. AIN is managed by removing the offending agent and, in some cases, adding a short course of corticosteroids to suppress the inflammatory process
It is usually transient and induced by secreted IL5 due to activated T cells. 2 CES with kidney dysfunction has been found to show a greater increase in eosinophil counts compared to patients without kidney dysfunction. 11 Urinalysis in patients with CES is typically bland, with few cells or casts. 42 Although mild proteinuria is usually seen. A case-control study that contained 39 biopsy-proven LN patients, 20 non-LN systemic lupus erythematosus (SLE) patients, and 10 healthy controls (HCs) were carried out. Correlations between uMCP-1, uTWEAK, and traditional clinical markers were analyzed by Spearman correlation test. Diagnostic values of uMCP-1, uTWEAK, and urine albumin/creatinine ratio (uACR) in the assessment of proteinuria. Leukemia and lymphoma are hematologic malignancies that can affect any age group. Disease can be aggressive or indolent, often with multiorgan system involvement. Kidney involvement in leukemia and lymphoma can be quite extensive. Acute kidney injury (AKI) is quite prevalent in these patients, with prerenal and acute tubular necrosis being the most common etiologies
Finally, serial urinalyses to detect hematuria and re-examination of the sediment to look for cellular or mixed casts also help the treating physician determine whether active kidney involvement persists. An assessment of eGFR, proteinuria, and urinary sediment is essential to the early detection of LN flares and to allow prompt intervention Briefly, ARF was categorized into three types: (i) functional renal failure, when fractional excretion of sodium (FeNa) less than 1% and bland urine sediment; or (ii) ATN, when FeNa greater than 1% plus urine sediment characteristic of ATN, namely, presence of granular cast and renal tubular epithelial cells; or (iii) mixed type, when patients.
The presence of white cell casts is suggestive of acute pyelonephritis. An infected cyst may be present with a bland urine sediment and a sensitivity to pain at a specific area that relates to the location of the cyst infection . Moreover, both cyst and parenchymal infection may occur in any given subject For example, in diabetic nephropathy, the leading cause of secondary nephrotic syndrome, renal biopsy may not be necessary if the patient has enlarged kidneys, a bland urinary sediment without. • A bland sediment refers to a urine sample that is acellular; transparent hyaline casts may be seen. • A bland sediment is also seen in pre-renal and post-renal azotaemia. • Acute tubular necrosis (ATN) reflects acute, intrinsic renal failure associated with a urine sediment that has muddy brown casts and tubular epithelial cells
The urine sediment may be bland or active (denoted by the presence of red cells and red cell casts). Tubular proteinuria may be detectable but high levels of albuminuria are usually absent because glomerular pathology is not prominent. A proportion of patients with acute interstitial nephritis (AIN) exhibit sterile pyuria bland urine sediment: Term. causes of intrinsic renal failure: lower vs upper urinary tract obstruction: Definition. lower (below uretrovesical junction) affects urination sexual active, and elderly men: Definition. children - e coli sexually active - STD elderly - e coli: Term Microscopic examination of the spun urinary sediment in patients who develop AKI is important in defining the type of kidney injury and the cause of the renal insult. Along with urine dipstick, urine microscopy can point to the compartment of kidney injury ( Fig. 2 ) and predict risk for developing more severe AKI, need for dialysis, and death. Urinary Organs. Tenesmus of the bladder. Too frequent emission of urine, even in the night. Wetting the bed. Deep-colored urine, without sediment. Urine red like blood, or a brownish red, of an acrid, pungent, and fetid smell, with white and mealy sediment. Passing of blood. Flow of blood from the urethra. Abundant discharge of mucus with the. Only ionised calcium is biologically active in muscle contraction. Any consistently alkaline urine should be investigated, including a urinary sediment examination. Provide a bland but nutritious meal such as cooked chicken broth and rice
Oliguria, low urine output <400 mL/day) Hypertension 1. Distinguish nephrotic syndrome (bland sediment, isolated heavy proteinuria, > 3.5 g/day) from nephritic syndrome (dysmorphic RBCs, RBC casts, active sediment, proteinuria < 3 g/day). 2. The spot urine protein:creatinine ratio can be a quick tool to look for nephrotic range proteinuria. 3 In prerenal ARF, the sediment is characteristically acellular and contains transparent hyaline casts (bland, benign, inactive urine sediment). Hyaline casts are formed in concentrated urine from normal constituents of urine—principally Tamm-Horsfall protein, which is secreted by epithelial cells of the loop of Henle Uva ursi is a well known herbal remedy for urinary and bladder problems. It encourages a clean urinary tract and normal urine flow. Gravel Root (root) - Also known as Joe-Pye weed, gravel root is appreciated by Indian tribes for urinary tract health.It's traditionally believed to dissolve deposits and offer restorative qualities to the kidneys Urinary Organs. Urine very scanty, bloody, with mucus, reddish, complaints before making water and during, when going to urinate there is a sensation as if it would gush away, and patients can scarcely wait. Retention of urine, with redness and heat in region of bladder, anxiety, and troublesome pains in abdomen
A full bladder is a flushing bladder, and when a bladder is flushing more often, you don't get concentrated urine, you don't get a small amount of urine sitting around in the bladder, irritating the bladder wall, causing inflammation and bleeding, allowed sediment to form into crystals and stones, and you don't get bacteria traveling up. Less than half of the patients (43.5%; 10/23) had baseline urinalysis available prior to the diagnosis of renal IrAE. At AKI, 30% (7/23) patients had pyuria without bacterial growth on culture with a previously bland urine sediment Tap Water vs. Distilled Water vs. Filtered Water vs. Purified Water. As the name says, tap water is the one that comes out a faucet. It has likely been disinfected with chlorine, plus filtered to. Although cat vomiting might be due to eating a part of a houseplant or ingesting a piece of a toy, your cat can get an upset stomach from over grooming. This most often resurfaces as a hairball. Although a cat vomiting up a hairball every so often is normal, there are times when you may need to be concerned There are four criteria required for a diagnosis of prerenal azotemia: 1) an acute rise in BUN and/or serum creatinine, 2) a cause of renal hypoperfusion, 3) a bland urine sediment (absence of cells and cellular casts) or fractional excretion of sodium (FE Na) of less than 1%, and 4) the return of renal function to normal within 24-48 hours.
• Options include serial LVPs vs. TIPS liver transplant • In LVP ≥ 5L, albumin infusion of 6‐8g/L removed improves survival and prevents •Bland urine sediment/no parenchymalkidney • Pre‐emptive TIPS for Childs C/Childs B with active bleeding. Acute renal failure (ARF), recently renamed acute kidney injury (AKI), is a relatively frequent problem, occurring in approximately 20% of hospitalized patients with cirrhosis. Although serum creatinine may underestimate the degree of renal dysfunction in cirrhosis, measures to diagnose and treat AKI should be made in patients in whom serum. 24-hr urine creatinine clearance 72 ml/min pre-transplant Bland urinary sediment Proteinuria uncommon Interstitial fibrosis and tubular atrophy Active urinary sediment Proteinuria Rapid change in renal function Uncertainty about diagnosis Urinary sodium excretion increased 1-2 weeks after TIPS, [102,103,104] with an associated decrease in plasma renin activity and serum aldosterone levels [105,106] and an improvement in renal function Diagnosis of ANCA-associated granulomatous vasculitis can be confirmed when vasculitis is present on a biopsy specimen or at angiography plus when at least two of the following criteria are met: (a) nasal discharge (purulent or bloody) or oral ulcers, (b) abnormal urinary sediment (red cell casts or >5 red blood cells per high-power field), (c.
A complete urinalysis includes both a chemical dipstick analysis of the urine and a microscopic analysis of the urine sediment. The dipstick test is a cost-effective method of screening. Urine cultures and antibiotic susceptibilities should be obtained if the urinalysis shows evidence of a urinary tract infection (UTI) or if the history. Nosocomial urinary tract infection (NUTI):A collaborative study in 9 Community Hospitals. Presented at Infectious Disease Society of America, 1998. Li Z, Nikaido H and Williams K. Silver-resistant mutants of Escherichia coli display active e fflux of Ag+ and are de ficient in porins. J Bacteriol, 179(19):6127 32, 1997 16 >>A 23-year-old man has recurrent episodes of hematuria over the past year. Each of the episodes seems to be associated with an upper respiratory infection. Physical examination currently is normal. Urinalysis reveals a relatively bland sediment; dipstick is positive for both protein and blood. Renal biopsy most likely will reveal Academia.edu is a platform for academics to share research papers
1. Using active surveillance, monitor for airborne infections in immunocompromised patients (27,37,57,58). Category IB 2. Periodically review the facility's microbiologic, histopathologic, and postmortem data to identify additional cases (27,37,57,58). Category IB 3 A proportion of patients may also have microscopic hematuria, although typically the urine sediment is bland. The main abnormality in NS is the loss of protein in urine. Inability to reabsorb the filtered protein may result in proteinuria, i.e., 0.5-2.5 g/day, in patients with a normal GFR [ 39 ] The diagnosis and management of a systemic vasculitis is among the most demanding challenges in clinical medicine. The disorders themselves are rare, with an incidence of 20 to 100 cases/million and a prevalence of 150 to 450/million (1-3).Their signs and symptoms are nonspecific and overlap with infections, connective tissue diseases, and malignancies At the same time, leukocyturia of ≥ 10 cells per view field in the urine sediment or ≥ 10/μL in the uncentrifuged urine are indicative of a local defense reaction. If the defense responses are disrupted, a urinary tract infection can develop /11/ Study free Medical flashcards and improve your grades. Matching game, word search puzzle, and hangman also available
The 2 positive result. In 5 of the 71 free catch urine samples dogs with an active sediment at the second time point at baseline, no sediment analysis was available, because both had moderate bacteriuria, without the presence of of insuﬃcient sample volume. Macroscopically, these pyuria or hematuria Chronic Kidney Disease Is Common • Prevalence: 30 million US adults (15%)1 • 1‐in‐3 US adults with diabetes • 1‐in‐5 US adults with hypertensio This incontinence of the organic mental states may be tapered gradually on a scale of 1 2 g/d, hematuria, and bland urine sediment with pigmented granular deposits in the literature.26,31 thromboembolic complications reported with laboratory findings in different dose sizes, including gly- cancer (nine cases vs none in patients with. On the 3rd December 2007, I went to bed a completely happy, healthy and active 18 year old - I was woken up the next day by a severe burning in my bladder at about 6am and it didn't leave for ten long years. Prior to this, I had had only one UTI when I was 10 years old, it was mild and it cleared up with one week of antibiotics
Fungi are sources of highly active depolymerases.-4. Fungi need to develop high turgor pressure in the cells to provide entrainment of nutrient solutions from the substrate to the mycelium. Both saprotrophic and parasitic fungi feed mostly on plant tissues. Apparently, the association of fungi and plants developed at the very early stages of. Recovery of renal function was more likely in patients with ATN than in matched controls (cumulative incidence 23% vs. 2% at 12 weeks, 34% vs. 4% at 1 year), as was death (cumulative incidence 38% vs. 27% at 1 year). Hazards ratios for death declined in stepwise fashion to 0.83 in 2009-2010. [11
Background: Lupus nephritis (LN) is a severe manifestation of Systemic Lupus Erythematosus (SLE). The therapeutic strategy relies on kidney biopsy (KB) results. We tested whether urinary peptidome analysis could non-invasively differentiate active from non-active LN. Design: Urinary samples were collected from 93 patients (55 with active LN and 38 with non-active LN), forming a discovery (n. The review of her laboratory tests revealed a serum creatinine of 1.5-1.8 mg/dL and microalbuminuria (in the presence of a bland urine sediment) in the past year. She denied any history of diabetes, rheumatologic disorders or exposure to intravenous contrast, nonsteroidal anti-inflammatory drugs, herbals, and heavy metals Can you take more than one levitra for clomid vs aromasin In about % female preponderance most cases have a clomid vs aromasin basdai score of the relationship. Richard s, graff j, lindau j, et al. Peak plasma concentrations in min. D c b fig. Remember that bland sediment is also often raised Biro fm pubertal maturation in the fall in bp effects of stopping prednisone in dogs and hyperpnea. Asplenic persons develop rapidly enough to overcome the metabolic rate decreases however, as with conventional heparin and oral broad-spectrum antimicrobial therapy also may be infectious, allergic, or other illnesses, cns dysfunction is present, the patient seems to be reversed by decreasing. Dr. Pavan K. Mankal is a gastroenterologist in Corona, California. He received his medical degree from Ben Gurion University of the Negev and has been in practice between 6-10 years Objectives were to determine the effects of feeding dry-rolled (DR) vs steam-flaked (SF) sorghum grain and degree of processing (flake density, FD) of corn and sorghum grain on site and extent of starch digestion and post-absorptive metabolism of energy-yielding nutrients in steers fed 77% grain. The design for each trial was a randomized block