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Mystery metabolic acidosis 21 years after kidney-pancreas transplant  
A 60-year-old man developed severe metabolic acidosis 21 years after a kidney-pancreas transplant. Several etiologies are proposed, including bladder drainage of exocrine pancreas (urinary loss of bicarbonate) and the use of cholestyramine (anion exchange resin), but nothing fits the timeline or the radiographic data. While there is no answer to this mystery, the discussion is enlightening. See for yourself.

Summary provided by Roger Rodby, MD, FASN.
Previous Community Minded Summaries are available at: https://community.asn-online.org/browse/communityminded