WILTIMS #261-5: Renal wrap-up with a side of death and vodka

Another week, another pre-exam post! This was a tiny block of material compared to the last couple, but boy have the kidneys made up for it with complexity. And just to make things more interesting, we also threw autoimmune/connective tissue diseases into the mix. The upshot of those is lupus can cause anything. There. See? Now you know as much as I do! erm... I mean, I totally know more stuff grumbleantiDSgrumblerheumaticgrumbleSmithgrumbleSjogren's...

Anyways, here's a thingy I made for brushing up on the basics of renal physiology and pharmacology:

Click to enlarge

Simple right!? In all honesty, even though it's super complicated, I love learning about the kidneys. They do incredibly important things with an efficiency and precision that's astounding. Of course they also like to freak out and kill you when they get confused, but that's fun too, in its way.

Heart: Ugh, I just can't do it! I can't take any more blood pressure...
Kidneys: What's that Heart? More blood pressure? We've got your back!
Heart: What? No! I'm already exhausted why would I want more blood pressure!?
Kidneys: Even, more!? Wow!
Heart: NOOO!
Kidneys: WE'RE HELPING!

MondayIL: The title coroner originally meant a representative of the King (hence the corona root) whose job was to make sure a person was truly dead, because at death all debts return to the crown. Being "dead" was a great way to dodge your debt.

One of the few interesting things to come out of an optional talk I went to this evening was a great analogy about the murkiness of defining death: defining death is like defining blindness. You can be legally blind while still being able to perceive light. The point of the definition is that beyond some threshold, one's eyes are no longer able to do that which gives them purpose. Similarly, you can be legally dead without having lost all of your bodily functions. But is a beating heart or breathing lungs lying on a bed really a person by any meaningful definition?

TuesdayIL: Autosomal dominant polycystic kidney disease makes for some HUGE kidneys. Today was a gross specimen review and there was one set of kidneys that we jokingly said we would have believed was a brain or lung, had it been labeled so.

WednesdayIL: If you try to poison someone with ethylene glycol (antifreeze) you'll get caught on autopsy when they find calcium oxalate crystals in the kidney. Oxalic acid is one of the breakdown products of antifreeze and, while the poison's trying to kill you, the kidneys try to filter it. As the urine gets more concentrated with the oxalate, it forms very specific kidney stones which, you'll remember from the other day, look like letter envelopes. Counteracting this type of poisoning is also one of the few instances where giving IV ethanol (yep, think the world's purest vodka straight into your veins) is an acceptable treatment. The alcohol blocks the enzyme that breaks ethylene glycol down into its poisonous byproducts, giving the body more time to filter all of these chemicals out of the blood. So if you're poisoned, the drinks are on us!

Thursday I Learned: that I do, in fact, know some things! Today was another four-month checkup with my oncologist. (All is well, by the way.) While I was there, the doctor was interrupted by a nurse, who was asking what the reason was for admitting another patient to the hospital. "Her hemoglobin is 5..." he said, a little incredulously, before rewording it in a way that a hospital would approve of. As he turned back to me, he saw my eyebrow-raised expression, and chuckled. "You know how bad that is now, don't you?"

It's the little things that remind me that I am actually making progress.

Friday: Today we had a small-group case study that was based on a tragic real-life case of deadly misdiagnosis. That sounds rather depressing, but because we are highlighting it, 200 soon to be doctors won't ever make that same error. Mistakes happen all the time in medicine; we're only human. But we can honor the people we harm, by learning and teaching about the mistakes we make.

The mistake in question: A slightly elevated creatinine level on a petite female is indicative of much worse renal/urinary problems than a simple UTI.

FridayIL: How to sign "Where does it hurt?"

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