Nephrology complete!

Last day in the Doctor's office on the Nephrology ward.

My time in Nephrology has ended, and for the first time since starting my rotational year, I am feeling a little sad to leave a department. I’m not quite sure what it means, but with four more weeks of Internal Medicine, I hope I am closer to figuring out if this is a speciality I want to build a career in. 

They say, "time flies when you're having fun!" Well, I guess it's true. I feel like it was just yesterday that I started my rotation in Nephrology. I can't believe it's been four weeks! Four whole weeks.  

With this rotation, I have become much more confident in seeing patients on my own and less nervous about the language barrier. Four takeaways I would like to share from this rotation are:

• A clinical sign of weight/fluid loss in a dialysis patient is hypotension (decreased blood pressure), while a clinical sign of weight/fluid gain is dyspnea (difficulty breathing).
• In patients with complaints of dyspnea, you should check jugular vein distention, pitting edema in lower limbs, and listen to lungs bilaterally for crackles. All the above can indicate fluid overload, which sounds great in theory, but a patient could be fluid overloaded and not present with any of the above during clinical examination.
• In chronic kidney disease patients, you have to look for uremic symptoms. These include rash/itching, nausea, vomiting, lack of concentration, fatigue, and weakness.
• The antibiotic, Vancomycin, can be used for all Gram+ bacteria, except where there is known resistance. While this makes it a great drug choice because of its broad spectrum, it is nephro- and oto-toxic, meaning it can cause kidney and ear problems. Because of this, when using Vancomycin to treat infections in chronic kidney disease patients, the levels in the blood must be tested every 2-3 days to prevent toxicity.

These are not necessarily new things, but more so things that the doctors emphasised.

Next week, my Internal Medicine rotation continues. The plan was to begin in a new subspeciality, Gastroenterology, but after speaking to my supervisor, I will be in Hepatology instead. Either way, I am excited to see what the remainder of my rotation holds.