Nephrology and kidneys

142 articles · Since 2011

Articles, page 7

When patients need to find a new equilibrium

July 18, 2012Jul 18, 2012

Chico (all identifying information removed) was a patient we cared for in the hospital. Admitting diagnosis: “acute kidney injury,” medical-speak for kidney failure. He would need dialysis. From my point of view–an instructor teaching residents and medical students–there were two…

Chico (all identifying information removed) was a patient we cared for in the hospital.

Admitting diagnosis: “acute kidney injury,” medical-speak for kidney failure. He would need dialysis.

From my point of view–an instructor teaching residents and medical students–there were two key questions about Chico:

1. What caused his kidneys to fail?

2. Given his kidney failure was “acute,” was there any chance that it’d be reversible? Could Chico’s kidneys heal to the point where …

Health policy

What does an ACO mean in small town America?

Robert Provenzano, MD

June 9, 2012Jun 9, 20123

At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital…

The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …

Conditions and diseases

Is the daily blood draw in the hospital truly necessary?

Ioana Baiu, MD

June 5, 2012Jun 5, 2012

One of the most memorable discussions regarding the cost of care was at 4:45AM during surgical morning rounds. As usual, the interns would present the overnight events of their patients to the chief resident and a plan for the day…

One of the most memorable discussions regarding the cost of care was at 4:45AM during surgical morning rounds.

As usual, the interns would present the overnight events of their patients to the chief resident and a plan for the day would be agreed upon. These morning rounds were particularly intense: in addition to the 30 patients that an intern had to manage solo over night, the brutal hours that the surgical …

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Physician voices

Failure of communication led to an excessive hospital stay

Kelly Donovan

May 24, 2012May 24, 201210

On a late afternoon in mid-July I was finishing up my first Sunday on call as a third year medical student. I glanced over the patient list for 4 East, the internal medicine floor I had been assigned to cover. Familiar with patients in their eighties and nineties, I was surprised to see a 22-year-old patient admitted with acute kidney injury.

He was a nice-looking young man in good spirits. Spanish …

Conditions and diseases

How transplants are causing ethical dilemmas

Janet Radcliffe Richards

May 14, 2012May 14, 20122

The trouble with many significant advances in medicine is that that they take us out of our moral depth. They may raise quite different problems from the ones we are used to and, if we are not careful, we may inadvertently undermine the wonderful potential of new technologies by forcing them into existing legal, ethical and institutional frameworks.

Transplantation is a case in point. Transplants save and transform lives; but the …

Physician voices

Is patient-centered care an outmoded concept?

Robert Allan Bear, MD

April 21, 2012Apr 21, 201211

Hospitals commonly espouse a commitment to patient-centered care (PCC). Most fail to achieve it. Causative factors are legion. PCC is often considered a strategy or a tactic, for example, when it really should be integral to an organization’s culture, and enabled by a supportive vision. Some organizations appreciate this, yet still struggle. This is understandable. Today’s health care providers were not trained to provide PCC. They lack the requisite skills, …

Physician voices

What does writing fiction and being a doctor have in common?

Richard Barager, MD

April 14, 2012Apr 14, 20125

I have been asked a lot lately, owing to the release of my novel Altamont Augie, what writing fiction and being a doctor could possibly have in common? Patients and colleagues seem shocked that the rational, left-brain doctor they have…

I have been asked a lot lately, owing to the release of my novel Altamont Augie, what writing fiction and being a doctor could possibly have in common? Patients and colleagues seem shocked that the rational, left-brain doctor they have come to know and depend on to deliver technologically complex medical care to patients with kidney failure could produce such a right-brain thing as a novel. Where did this …

Conditions and diseases

Reducing the need for dialysis

Allen R. Nissenson, MD

March 26, 2012Mar 26, 20122

One pitfall of some of the incredible medical advances over the last century is that we too often forget what it was like before. Before penicillin in the 1940s, thousands died of simple infections. Before a cure for polio in…

One pitfall of some of the incredible medical advances over the last century is that we too often forget what it was like before.

Before penicillin in the 1940s, thousands died of simple infections. Before a cure for polio in the mid-‘50s, tens of thousands were sickened, killed or disabled.

And before outpatient dialysis became widely available in 1972 – 40 years ago this year – 100,000 Americans died of kidney failure …

Read more…

Reducing the need for dialysis

Medical education

A medical student is forced to step beyond the things he knows

Rick Pescatore, DO

February 1, 2012Feb 1, 20122

There comes a moment when you're forced to step beyond the things you know. It's a split second -- an instant adjustment from the safety of recollection to the insecurity of the unknown. Day after day we head into the…

There comes a moment when you’re forced to step beyond the things you know. It’s a split second — an instant adjustment from the safety of recollection to the insecurity of the unknown. Day after day we head into the library, hunching over twice-reviewed notes and hidden behind piles of books yet to be read. We push ourselves to work harder, study longer. We toil knowing that each page holds …

Conditions and diseases

Chronic kidney disease from a patient perspective

Gail Rae

January 1, 2012Jan 1, 2012

An excerpt from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. The symptoms of kidney disease don’t show up until you’ve lost most of your kidney function. That’s when you’ll experience the fatigue that’s…

An excerpt from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.

The symptoms of kidney disease don’t show up until you’ve lost most of your kidney function. That’s when you’ll experience the fatigue that’s not always a result of anemia, the muscle cramps that usually – but not always – present themselves in your calves, nausea, vomiting, appetite loss, easy bruising, itching and the shortness …

Conditions and diseases

MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema

mksap

December 10, 2011Dec 10, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks in …