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![drjamesdinic Avatar](https://lunarcrush.com/gi/w:24/cr:twitter::2832261790.png) James DiNicolantonio [@drjamesdinic](/creator/twitter/drjamesdinic) on x 205.8K followers
Created: 2025-07-18 23:59:30 UTC

Here’s one of my review articles on low grade acidosis

The kidney have a limited capacity to excrete hydronium ions (“acid”) before there is some retention (half the population will retain some hydronium ions if the net acid excretion is somewhere between 40-70 mEQ (ie urinary pH of 6-6.5) (see screenshots). 

Yes we can buffer the acid load but there are consequences to doing that:
1.) Bone breakdown
2.) Negative calcium balance
3.) Increased production of ammonia
4.) Increased urea production
5.) Hyperfiltration at the kidney level
6.) Increased albuminuria in those with good renal reserve who have the ability to dramatically increase GFR after a high protein meal
7.) Increased propensity for uric acid and oxalate kidney stones

![](https://pbs.twimg.com/media/GwLbYQLWEAI8YLB.jpg)

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