Nephrologists are the smartest doctors
Change my mind
I have never felt so dumb in my life
Every rotation I have been in so far, you know, I have been able to hold my own. Like if a doctor asked a question, I could at least make an educated guess. Until I started nephrology and oh my God. It is sooo focused on physiology and you have to remember every tiny detail and you need to keep in mind these patients probably have kidney failure and their electrolytes are meant to be all over the place and oh god i’m getting a headache just thinking of this. Yeah, long story short - Nephrologists are honestly really the smartest doctors in the hospital.
Check out the tik-tok by drglaucomflecken that makes me laugh about nephrologists. Check more of him out, he is hilarious
What I learnt
In all the other wards, when you look at the Urea & Electrolyte (U&E’s) everyone for some reason only cares about Sodium (Na), Potassium (K) and Calcium (Ca).
On our first day in Nephrology, the doctor asked us what does phosphate do, and I was so lost for words until he revealed the different functions of phosphate (one of them being energy, because of ATP… duhh)
Something interesting I learnt that I never really knew.
Vitamin D’s function is to help absorb Ca and Phosphorus (P) from the gut into the blood. Therefore, LOW levels of vitamin D, would mean low levels of Ca and P right? not necessarily (or maybe for a very short period of time) - BECAUSE
When the parathyroid realises that Ca levels are sinking, it releases Parathyroid hormone (PTH) which gets the body Ca and P from the bones, through the use of osteoclasts. Chronic situations can lead to osteomalacia.
Not sure why I chose to share this piece of physiology but it was just interesting to me and I didn’t know about this so maybe someone else will benefit from it too.
Just to add to this knowledge train.
If you have high levels of P, you can give someone a medication that they take when they have food which causes the P to bind to it and pass through the intestines without getting absorbed. If the P levels are dropping, you stop that medication. It’s a sea-saw type of medication.
If someones PTH is high, you give them calcium mimetics. What this does is that it tricks the parathyroid into thinking that there are enough calcium levels in the blood, therefore PTH doesn’t get released. This is a calcium mimetic, so not the ACTIVE form. One of the main side-effects of this is that calcium will stop getting absorbed from the diet because of the mimetic and PTH isn’t working because it thinks there is enough Ca therefore someone can develop HYPO-calcaemia.
Keep an eye out for low levels of Ca and watch out for CLINICAL SIGNS & SYMPTOMS of HYPO-calcaemia.
***All the information above was taught and explained to me in the context of patients receiving haemodialysis***
***NONE of this should be used as medical advice or to used a source to make clinical judgements. The aim of medical content on this newsletter is to make you aware of things or remind you of things that you then SHOULD research for yourself and confirm or discuss with seniours***
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My name is Habib and I am a 5th-year Medical student currently in Cyprus. I grew up in Tanzania (Hakuna Matata is from the local language of my country and the second tallest mountain (Kilimanjaro) is found there).
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