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Progressive nephron destruction over time leads to progressive loss of renal function 

chronic renal failure is not reversible due to nephron destruction 

if all nephrons have been irreversibly damaged - known as “end stage kidney”

uraemia, polyuria, biochemical change

however less metabolic disturbance than with acute TRF (total renal failure)

Potential causes:

vascular disease 

glomerulonephritis 

diabetes 

Response of Glomeruli to damage

Endothelial cell proliferation: 

occlusion of capillary; reducing flow through glomeruli - correlates with oliguria and uraemia 

Mesangial cell proliferation: 

associated with increased matrix production

 over many years leads to sclerosis and loss of capillary lumen 

Basement membrane thickening: 

e.g. may be due to immune complexes or amyloid 

(the above are an attempt of regeneration in response to inflammation)

Capillary wall necrosis: 

usually fibrinoid; e.g. necrotising vasculitis, malignant hypertension 

 Crescent formation: 

epithelial cell proliferation; reaction to glomerular capillary damage 

severe glomerular damage only - large numbers = poor prognosis

characterises rapidly progressive disease 

serum proteins and fibrin in Bowman’s capsule cause overgrowth of the epithelial lining 

as crescent enlarges - compresses the glomerular tuft - which shrivels and becomes non-functional

once crescents are established disease type can only be determined by examining unaffected glomeruli

“If you become chief resident are you just going to get pregnant and have a baby?” asked the silver-haired male attending physician as I sat interviewing for the prestigious academic position of chief internal medicine resident. “That’s what all the female chiefs do, and I’m tired of it,” he added, shaking his head in clear disgust.

Gobsmacked by the blatant sexism of his interview technique, I laughed nervously and made some lame joke about working so much that I barely had time to see my husband, let alone make babies with him. Feeling absolutely professionally alone, with no good means of reporting the incident, I quietly pulled my application and plowed on through residency and life, eventually giving birth to a son at the very end of my training.

My experience is hardly unique: 4 out of 5 physician mothers say they experience workplace discrimination, according the results of a study published last week in JAMA Internal Medicine.

Please reblog this if you’re still an active Medblr! I’d like to follow more of you, and I feel like a lot of the big medblrs aren’t very active anymore. And say what year in med school you are and maybe country? I know some people prefer to stay mostly anonymous.

NEW FRIENDS!

Dr. Mike McInnis, DIT

Dr. Armand Trousseau (1801-1867) was a French internist who made many contributions to medicine, not in the least his two eponymous signs. I can’t imagine what it would have been like to discover the signs of a malignancy, and then later see them in yourself. He died from his cancer at age 65. 

2017: Week 12 | Mar. 19 - Mar. 25

“Those who don’t know how to make love make war.” -The Patience Stone