Nephrology question regarding positive outcomes

[cfdavid]

Hey guys,

Can someone please shed some light on the realities of renal practice/treatment. I've watched some videos describing peritoneal and hemodialysis, and it's clear that without a transplant these therapies (albeit necessary and lifesaving) have a huge impact on a patients life. They are intense, and time consuming, not to mention permanent. Quite a bummer.

From an outsider, it seems that renal patients are almost treated in a palliative sense. And that kind of practice is not for everyone. So, what other outcomes (more positive, and perhaps permanent) could a nephrologist offer a renal patient.

In other words, other specialties can see more instant gratification due to a very quick improvement in a patients condition. The obvious of these would be a surgical procedure that simply fixes a problem. But, others would include interventional cardiology in which stent placements in coronary arteries have a near immediate and pronounced positive effect on the patient.

I'm kind of a more instant gratification type dude. Can a nephrologist offer instant gratification/improvement to their patients? I'd imagine there are many/varying stages of renal disease.

Can you be as specific as possible, like "patient comes in with severe, debilitating, water retention, and our methods/therapies fix that in a matter of days".....

Thanks a lot. I do realize that this thread borders on the "bush league". But, any insight is welcomed.

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[Becket]

There are some such situations, such as "patient comes in severely volume-depleted with prerenal azotemia, improves with a few liters IV fluid"; however, renal is not the field to go into if you're looking for quick turnarounds. Most of your patients,certainly as outpatients, will be chronically ill with HTN and/or diabetes and while you can certainly work to slow the progression of kidney loss, you're not going to ultimately reverse it. Inpatient consultations may provide a bit more variety, as a lot of causes of acute renal failure in the hospital can be reversed (pre-renal as discussed above, ATN, drug-induced, contrast nephropathy, etc.)..usually just takes some time (i.e. few days at least except for pre-renal, which can turn around rapidly), some IV fluids, ruling out a bunch of other things, and stopping any drugs that can do even more damage. Don't know if this adds up to "instant gratification."

 

[cfdavid]

Becket, thanks for the great insight. That's what I was hoping for.