WILTIMS #483-7: Nephrology - Part II

This is part II of my rapid-fire catch-up series. Click here to read "Nephrology - Part I" which was posted only an hour before this post.

One of the things that I find endearing about nephrology is that when you work in a hospital, you already know most of your inpatients very well. That's because one of the biggest predisposing factors for acute kidney injury is chronic kidney injury. Dialysis patients are always a knife's edge (or 2-3 days without a dialysis treatment) away from the emergency room. If your kidneys are totally non-functional then you need dialysis at least 3 days a week. If you miss an appointment, the toxins that the kidneys (or dialysis machine) should filter from the blood can cause all manner of dangerous side effects very quickly. When these patients show up in the ER, though, it's not like a typical consult for the nephrology doctor. You've seen these patients 3 times a week for months, years, or even decades.

My final thoughts on nephrology are similar to my thoughts on pulmonology: working with just one organ system is incredibly frustrating. In pulmonology, we often started reading up on a patient not by reading the history and physical, but by looking for a chest x-ray or CT scan. All we cared about was the lungs. We once had a family ask about the patient's brain tumors and we honestly didn't know they were being treated for that; all we cared about was their pneumonia. In nephrology, we were very big on the blood tests. If a patient we'd followed for several days didn't have blood work ordered by the primary team, we might not even bother seeing the patient that day.

I don't want to work in a field that can clear a patient "from the [insert organ here] perspective." How is the patient? Well she's fine from a kidney perspective (but I think I saw a note that her leg needs to be amputated and the septic blood infection from her UTI is life-threatening). I'd much rather be in charge of the whole picture and ask other colleagues to comment on their particular organs. But that's just me.

MIL: If a patient has any amputation due to diabetes, they have a 48% chance of having another amputation within 3 years.¹

TuIL: If you google the acronym "MMF," the definition offered by urban dictionary is not medical meaning of mycophenolate mofetil, a immunosuppressant enzyme inhibitor used to prevent transplant rejection.

WIL: The maximum renal clearance in a healthy young adult male is estimated at 180 liters per day.

ThIL: Dialysis disequilibrium syndrome is an increasingly rare reaction to the abrupt change in blood contents after a patient first has a dialysis session. It's normally seen hours after the dialysis session starts, once the blood is mostly clean.

from http://kidneystones.uchicago.edu/

"Dialysis reaction" is a reaction of the blood to the membrane used in older model dialysis filters. Compared to disequilibrium reactions above, these dialysis reactions happen almost immediately after beginning the dialysis session.

FIL: Medullary sponge kidney is a congenital disease of the kidneys where the kidneys look like - you guessed it! - sponges. These porous, cystically dilated kidneys usually cause very few, if any, symptoms. The only problem that sometimes arises around middle-age is that the kidneys repeatedly form large stones that can cause obstruction of the ureter and damage the kidney. If it's not caught quickly, the affected kidney can fail entirely and, given the mildly debilitated other kidney, cause the patient to need periodic dialysis.