Heart -check, lungs -check, brain -check! On to the next organ: kidneys! Compared with the previous three, the poor kidneys get no respect. But when things go wrong for your determined little blood filterers, you'll notice ...and/or die.
Tuesday: I had a preceptor visit today where I had my first experience with an interpreter. I'm actually amazed that it took this long! Last year, the doctors I worked with were both fluent in a several languages and mostly cherry-picked the english-speaking patients for me, so they wouldn't have to play both doctor and interpreter.
Today's patient was a ~80 year old woman who came in with her grandson. The patient spoke no english at all but her grandson was extremely well spoken. I quickly saw, as we were warned in our FCM class, that a using a family member as an interpreter could be dangerous if you don't trust the interpretation or motives. Even something as innocuous as "I'm sure what she means is..." can dramatically change the narrative you're hearing from a patient and the clinical picture you base medical decisions on.
This particular interview went surprisingly well and I think I was able to get nearly all the information I wanted. Figuring out the type of pain being felt was particularly difficult. It wasn't sharp, dull, stabbing... and whatever the word was she saying didn't quite translate. We eventually settled on "tingling," which matched the our physical exam findings of nerve-associated dysfunction.
Today's patient was a ~80 year old woman who came in with her grandson. The patient spoke no english at all but her grandson was extremely well spoken. I quickly saw, as we were warned in our FCM class, that a using a family member as an interpreter could be dangerous if you don't trust the interpretation or motives. Even something as innocuous as "I'm sure what she means is..." can dramatically change the narrative you're hearing from a patient and the clinical picture you base medical decisions on.
This particular interview went surprisingly well and I think I was able to get nearly all the information I wanted. Figuring out the type of pain being felt was particularly difficult. It wasn't sharp, dull, stabbing... and whatever the word was she saying didn't quite translate. We eventually settled on "tingling," which matched the our physical exam findings of nerve-associated dysfunction.
TuesdayIL: There are two broad syndromes of renal dysfunction and they are super-helpfully named: nephritic and nephrotic syndromes. Nephritic patients will have blood in the urine (hematuria), protein in the urine (proteinuria), high blood pressure, and a low urine volume. Nephrotic syndrome, by comparison, is markedly more severe proteinuria, low blood albumin levels (hypoalbuminemia), generalized swelling (edema), and high blood lipid levels (hyperlipidemia). Simple, right? And these are just broad categories that each specific renal disease shares some combination of features with.
WednesdayIL: Red blood cells should never be in the urine, but their morphology, when present, can hint at where the bleeding is happening. Crinkly red blood cells in the urine typically come from the upper urinary tract or kidney. This is might relate to the multiple changes in concentration and/or just being in the urine for a longer time. Normal looking red blood cells generally come from lower, in the ureters, bladder or urethra.
ThursdayIL: Foamy urine is indicative of severe proteinuria.
FridayIL: The indications for dialysis can be remembered by the mnemonic AEIOU:
Acidosis (low blood pH)
Electrolytes (ion imbalances)
Intoxication/Ingestion (toxic substances)
Overload of fluid
Uremia (severe blood loss through the urine)
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