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I'm currently in the process of applying for fellowship in clinical nephrology.

Experienced fellows or anyone with any experience, in which country would you prefer to be trained? And why?

For Ireland it would be with RCPI, and for Canada most likely with the university of Toronto etc.

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Is this white sediment normal when urine sits? Pic not mine, but got this result after collecting my urine. I read it can be lymph. Or can it be semen in urine, if I've been refraining from ejaculation? Urine's also frothy.

‚Äč

https://i.redd.it/b5v1ueezvzx21.jpg

I've been having elusive health issues for a couple years, with no answers:

  1. Hypercalcemia. Not cancer. Urine calcium/creatinine is normal.
  2. Elevated serum protein. Serum electrophoresis = not cancer, but "polyclonal hypergammaglobulinemia." BUT, urine electrophoresis w/ total protein returned protein fractions' "pattern consistent w/ glomerular proteinuria." Dr didn't follow up.
    1. Creatinine 131 mg/dL, Protein Total 80 mg/L, P/C ratio 61 mg/g creat.
    2. Albumin 55.2%, Beta Globulin UPE 29.5%, Gamma Globulin 15.3%. A/G Ratio 1.23
  3. Weight loss w/ inability to regain.
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My daughter is a 9 year old female. She has Cat eye syndrome. History of incontinence. The past 2 years she has experienced recurrent UTI due to E. Coli. 2017 renal ultrasound showed R kidney 10.9 L kidney 11.9 (2010 US showed kidneys at 7.5 7.7.) Urologists was not concerned about abnormal size. In the past 2 weeks she developed a UTI containing Strep Viridan. She completed 10 day antibiotic treatment. 48 hours after completion of antibiotics we performed another U/A which showed she had another UTI due to strep viridan. She is now on a 7 day treatment. Is it a new UTI or a resistant strain? Are large kidneys normal? Are kidney size and UTIs connected? Possible outcomes? We see another urologist in February but I'm too worried to wait just to leave with no answers. What can I do at home to speed up diagnosis?

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A 28 y/o F was found to have hypokalemia after what ER docs described as a panic attack (yes, even after knowing hypokalemia was present). Patient c/o of SOB, palpitations, and tingling of hands and feet. Patient had just been on a long run and reports hyperhidrosis. Patient was given IV potassium, EKG (normal) and discharged. No indication of diuretic/laxative use.

Patient would go on to have a similar event nearly a year later. Would be given potassium, dose was titrated up for a few weeks due to continued hypokalemia (~2.8). Patient would be referred to Nephrology and found to hyperaldosteronism and hyperrenin. Normal levels of calcium and magnesium were found. Patient was referred to Genetic lab where a hypomagnesia panel was done. Negative for Gitelman's et al genes tested. No CLCKNB was tested, because of normal magnesium levels. Patient's K+ now hovers around 3.5-3.7, when tested, with a 120 meq dose (40 TID) of K+ .

Patient still experiencing daily cramps, pleurisy and tetany which often are a source of embarrassment and work/life complications. Other sxs include weakness, fatigue and frequent headaches. Patient also experiencing intermittent water retention, noted by swelling of the feet, hand, face and abdomen (abs no longer showing). Nephrologist refuses to prescribe requested K+ sparing diuretic due to fear of hypotension. Even after patient referred to a study showing small changes in BP of about 6/4 mmhg. Patient's blood pressure is typically around 110/83 though it used to be lower when patient was active runner (~96/68). SSA and ssb were normal. ANA was positive (also positive in her mother recently if that's relevant).

Other abnormalities include; low PCO2, low Complement C4, hyperhidrosis, dry mouth, salt craving since childhood, polydipsia (~250-300 ounces of water daily), polyuria, persistent low grade fever (~99.1, up to 100.1), family and personal Hx of mandibular tori, kaliuresis.

Disclaimer; it is my fiancee and we are just looking for some thoughts on what it might be, how you might treat it, etc... We are constantly reviewing whatever research we can find and it's very interesting. Also she has been "diagnosed" with hyperhidrosis, but trust me a day in the gym she sweats as much as I sweat in the sauna and I have nearly 100 lbs on her.

So what are your thoughts? What do you think it might be? Anyone have any patients presenting similarly?

Anyone a patient? If so, have you had hyperhidrosis? Low grade fever?

Anyone in Houston want to let me shadow them? I'm only half kidding.

Thanks

Edit: Patient also wants me to mention the reticulated appearance on skin, thought to be either livedo or dowling degos by two separate physicians.

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Reddit - Nephrology by /u/simsimali - 6M ago
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*Sorry for the typo in title, should be 'swelling' - too late to change now!*

I'm a trainee biologist/biochemist, asking on behalf of a group of patients being treated by a particular specialist who deals with chronic UTI, mostly using long-term antibiotics.

A number of his UTI patients have recurring kidney pain, along with nausea, feeling generally unwell etc, but the specialist believes this to usually be a result of the kidney capsule swelling in response to a lower UT infection and not a true kidney infection.

Is this referred pain or 'swelling' something you would recognise as nephrologists? For example, this kidney area pain can be quite chronic for a subset of the women diagnosed with a lower UTI, but their GFR values are still normal after a few years of suffering this pain.

If the kidney discomfort indicated a genuine chronic upper UTI, would you expect to see the GFR values affected in this time, or any visible scarring on kidneys when scanned, etc? How long would the infection have to go on for the kidney to suffer damage?

I can't find anything in the literature about lower UTI causing persistent kidney area pain or swelling to the capsule. Yet, wouldn't an ongoing low-level kidney infection cause a drop in function..?

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Reddit - Nephrology by /u/honoroduo - 8M ago

Just like title says, first Year IM resident in the south east. What should I be doing now besides trying to find cases to write about. Also, not a strong applicant in terms of board scores, I couldn't find data in terms of what type of scores you would need for applying. Any help/advise would be appreciated. Thank you.

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