Dr. House, Sherlock Holmes and Medical Education

Medical TV shows such as Dr. House and detective books such as of Watson and Holmes have now entered medical education literature to deduce their use in deductive reasoning and diagnostic skills. Can they be used to teach students about diagnosis and how to think? Dr. House exemplifies rare diseases states most of the episodes presenting even in a more atypical manner. Can this teach students to diagnose more common entities?

A recent study in AJM this year from France analyzed 18 episodes of Dr.House and found that strategies used in the show were unrealistic and there is an information bias in the show and costs, risks and failures of treatments are not taken into account. Here is another perspective on this topic.
Interesting to see a physician's account of each and every episode of Dr.House.

Regardless of the shortcomings, many of us get joy and excitement from watching the sleuth diagnose yet another rare disorder: and to top it all- he is a framed as a board certified specialist in  infectious disease and nephrology!!

Wild Nephrology explored again

Soil samples from this locale provided material for WHAT renal immunosuppressive agent?

This is rapamune( sirolimus).  Most of you got this one. It was discovered by Brazilian researchers as a prodcut of bacterium streptomyces hygroscopius in the soils of the Easter Island also known as Rapa Nui.

The US President who died of Bright's disease is Chester A Arthur.
He was the 21st US President. ( 1881-85)

Interesting fact: Turtle urine

Recently, a study from Singapore published in National Geographic confirmed that turtles urinate via their mouth. Turtles put their head in the water but are not doing for breathing,drinking or any other purpose but urea losses. The investigators found that when studied, 50 times more urea than was present in the mouth discharge was found in the water that turtles were kept in. A special gene was discovered that found a specialized protein that expels urea via mouth. 

This is very interesting science and we hope that this will help humans one day and patients on dialysis. Is this gene even exist in humans? Perhaps but not as highly expressed. Would we want to have this gene? Check out the entire article at 
http://news.nationalgeographic.com/news/2012/10/121012-turtles-urine-pee-mouth-science-animals-weird/

World Kidney Day 2012

Today is World Kidney Day.  Lets take this day and pay respect to all patients who are living with kidney disease day and night.  Lets take this time to honor the family members that are also involved in the care of the patient with kidney disease.  In the last 4 decades, the kidney disease community has come a long way. Somewhere along the way, many lives were touched and many lives changed.  The care of the kidney patient is much different now then it was 50 years ago.




What we have now:
1. A much more affordable treatment modality that can sustain life with dialysis in the ESRD patient.
2. Much more successful and sophisticated outcomes of kidney transplantation.
3. More treatment options for glomerular diseases
4. A better understanding of anemia and bone disease in ESRD and CKD

Some Major Breakthroughs in Nephrology in last decade:

1. More dialysis is better and the data keeps pouring in on that.
2. APOL1 gene story for AA and FSGS
3. Membranous Nephropathy is not idiopathic anymore
4. Rituximab for ANCA vasculitis and Lupus Nephritis
5. The knowledge of the T regulatory system in transplantation and glomerular diseases
6. Anemia and the Hgb target changes due to novel findings of CREATE and CHOIR
7. Late vs early initiation of dialysis question perhaps answered?
8. sUpar as the cause of FSGS
9. Pre eclampsia is a VEGF related disease that effects the kidney
10. C3 glomerulopathy and its impact on how we view MPGN pattern of injury

Happy World Kidney day

Image courtesy: as stated above

IN THE NEWS: Another Detective Nephron Venture

Detective Nephron Strikes Again this June 2011 ASN issue with a new case. This time, check out the new character- Dr.Slit Podocyte! ;)
http://onlinedigeditions.com/publication/?m=15191&l=1

TOPIC DISCUSSION: Origins of the 1.73m2 in the GFR formula?

Why is 1.73 m2? and not just m2? and not any other number? Where does this all come from?
Basically, the simple answer is "arbitary".  The 1.73 refers to the standardized body surface area(BSA) used to normalize for all variables for an average 70kg man. Interestingly, this one paper that I reference below taunts the idea of this in a very comical way and shows where this originally came from.  Apparently in 1928, on a basis of just 8 children and 7 adults, the authors found a constant value can be substituted and they said it was 1.73m2- which was the mean of the areas of men and women age 25 from prior medical and acturial tables. So this was based on actuarial data showing the BSA using Dubose formula and then subtracting 1 inch from height in shoes and 5 pounds from weight in clothes and different variables for children and women.  Basically,this was based on american clothing standards and weights in 1920s.
Nothing has changed in using that number in last 80+ years.  The authors of the paper referenced below show that compared to 1920s, current average male weight is 80kg and hence the BSA should be technically corrected by 1.92m2 and not 1.73m2. 
Even if they chose less obese European population, it came to 1.86m2.  Interesting, if we did that, there would be an immediate 9% increase in world GFR per the authors. In general, to get a BSA measurement in the over weight and obese population is a tough task and not easy to measure- for us making GFR a harder thing to measure then as well as almost all measurements of GFR including MDRD correct for BSA and use 1.73m2.

"Is it a time to change or is 1.73m2 going to live longer than all of us like it has been!!"

 Re:f:
http://www.ncbi.nlm.nih.gov/pubmed/17445062
http://www.ncbi.nlm.nih.gov/pubmed/16693840
image source: wikipedia.com

"Brain Drain" in nephrology

A series of articles in ASN Kidney News and CJASN recently have highlighted the fact that Nephrology is having a brain drain and loss of interest in application to this field. As a results ASN has created a task force to create more people going into Nephrology.  To me - don't know why people choose what they choose but to all those undecided medical students out there and residents:- 

Renal Medicine is the BEST!! 

It has everything you want in it:

1. Excitement:- acute issues to combat like Hyperkalemia, acid base, HTN crisis and Acute Rejection and saving the graft.

2. Novelty:- Transplant Immunology is growing rapidly and new agents are coming to the surface to make the field more and more exciting. The fact that dialysis will soon be a device that can be carried around - future might be here. Organs being developed and created via stem cells- can't get better than that! 

3. Variety:- From Glomerular diseases that remain mysteries to all to the facets of dialysis. From acid base to hypertension management. From a simple Acute renal injury to a complex rapidly progressing vasculitis

4. Future:- Interventional Nephrology, Geriatric Nephrology, Onco-Nephrology and upcoming special fields one can master in this exciting field

5. Mind boggling:- Always makes you think! The "thinkers" as the other docs call us. Even "Dr.House MD" is marketed as a Nephrologist!!!  We make cool diagnosis all the time!!!

6. Empathy:- Dealing with ESRD and transplant, nephrologists are kind hearted and compassionate individuals.  

Medical students and residents:- go for the field of medicine, at least take a rotation and try it out. It will be worth your time. Give The kidney a chance! and it will make a difference in your education and career!

Take a look at recent article from CJASN 2011 May

http://www.ncbi.nlm.nih.gov/pubmed/21551020

http://onlinedigeditions.com/publication/?m=15191&l=1

Image source: Iheartguts.com

USA-Nephronpower Wordle( Nephrology Rules)

http://www.tagxedo.com/art/f70ea46370324042

Nephronpower Views

Thanks to Blogger newer techniques
Check out our new views at
http://www.nephronpower.com/view/snapshot
http://www.nephronpower.com/view/flipcard
http://www.nephronpower.com/view/mosaic

and many others
My personal favorite: Snapshot!

Top Ten Reasons to Love you Kidneys

10. They are the best "Shaped" organ in our body 
9. If it wasn't for them, you wouldn't be able to get rid of your body's wastes.
8. They are the "Smartest" organ in our body
7. If it wasn't for them, you wouldn't be able to get rid of your excess water
6. They are the " most complex" organ in our body( even more than the brain)
5. If it wasn't for them, you wouldn't be able to live just on bananas ( some people do)- very well engineered!
4. They are the "most successful" organ in our body( one might ask why:- born smart, has an objective, can go into pre- renal success all the time and has long term plans set from before)
3. If it wasn't for them, you wouldn't have healthy bones.
2. If it wasn't for them, you wouldn't have healthy blood.
1. They are the "HAPPIEST" organ in our body! A smiling kidney is a working kidney.

Keep everyone's kidney happy! Happy World Kidney Day Everyone!

http://www.worldkidneyday.org/

IN THE NEWS- DETECTIVE NEPHRON

The latest issue of ASN Kidney News debuts my column called Detective Nephron. 
Its a different type of teaching tool using creative writing in a funny manner to teach a certain point in nephrology.
Any advice is appreciated to improve it and cases are welcomed as well.

Funny Stuff

Top 10 reasons fellows went into nephrology: ( Courtesy Dr.Alan Perlman of Weill Cornell/Rogosin Institute)

10.       You can see more psychiatric patients in 30 minutes rounding in the dialysis unit than you will see in an entire year doing psychiatry.

9.         “My therapist told me it was a good way to control my nephromania”

8.         You can cheer up a patient with a failing transplant by telling them it’s just a good humoral rejection.

7.         When our patients are pissed, we take it as a sign of success.

6.         “Dialysis gives me the tickles.”

5.         The feeling of superiority you get the first time you urinate after rounding in the dialysis unit

4.         Dialysis patients love jokes about metabolic bone disease

3.         “I find that stabbing a stranger multiple times with a sharp stainless steel instrument helps me to relax.”

2.         “I thought finding an organ swapping program would enhance my lovelife”
1.           To channel a lifelong love of urine into a golden stream