PUZZLE:
A patient came in with urinary frequency & urgency.
Here is the urinalysis.

What do you suspect as the underlying cause?

(I will show the answer after a dozen or so replies.)

Thanks so much for very smart answers, everybody, quickly passing one dozen.

This patient wears a mask many hours per day. Here's what happened to the urine.

Obstructed air flow keeps more carbon dioxide for extended time in masked airspace --> more carbon dioxide in lungs -->

More carbon dioxide in lungs (hypercapnia) --> lowers pH -->
increasing acid condition (respiratory acidosis) overwhelms compensatory mechanisms of the body --> The kidneys now have the hard job of . . .

The kidneys now have the hard job of dumping acid. How do the kidneys get rid of bad stuff? Excrete that acid in the urine. --> Urinalysis shows very low pH, bottom of the chart: pH = 5.0. That's about as acid as coffee. Which is fine for coffee, but . . .

But not so great for urine, which reflects what got taken from blood (remembering that kidneys' main job is to clean the blood, by excreting less than ideal substances into urine for disposal).

So the moral of the story is . . .

The moral of that story is that #masks, by way of the lungs, not only harm the brain (hypoxia), and the heart (tachycardia) and the immune system (acid favors viral replication), but also the kidneys.

I am concerned that the hematuria and proteinuria may also result from this strain on the kidneys.

As nephrologist Dr. Humphries @DrsuzanneH says, "If you wear a mask, I hope you have strong kidneys."

It is now one day since this thread went somewhat “viral,” for which I have to express some dismay.

Other organs than the kidneys have shown strain under mask use, which seems to be widely acknowledged, but not very alarming to mask-wearers.

For example, . . .

It is widely acknowledged that people wearing #masks often suffer headaches, foggy thinking or lightheadedness. But this only seems to affect the brain, which is notoriously oxygen-hungry.

So perhaps brain needs are not seen as the most urgent consideration. Also, . . .

Also, many people have noticed higher heart rate while wearing a mask. This is because low available oxygen forces the heart to beat faster, to rush red blood cells around to the various body systems to try to meet ongoing needs, particularly the oxygen-greedy brain. But . . .

But perhaps that added strain on the heart is taken in stride, stoically, due to the compulsion to wear a mask.

And . . .

And mask use lowers oxygen intake while increasing carbon dioxide accumulation in the lungs, which leads to the acidic condition of hypercapnia.

And it is long-known and well-established that acidic conditions favor viral replication.

But . . .

But perhaps the public realizes that #COVID19 is not nearly as lethal as the US media portrays it to be.

So therefore, mask impairment of the immune system’s ability to fight viruses seems to be accepted by those who advocate mask use as a necessary disadvantage.

However, ...

However, when I posted a urinalysis from an anonymous mask-wearer, it surprised many people, and seemed to generate far more attention and anxiety than I had imagined.

Apparently, kidney health is seen by some people as more urgent than that of other organs.

So neither the brain, nor the heart, nor – even in 2020 – the immune system commands priority over the urgent and trending zeitgeist of #Masks4all.

And to my dismay, the kidneys may be the organs most cherished of all by many people. Interesting.