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Latest Posts

What Do Your Kidneys Have To Do With Finding Nemo?

Finding Nemo is one of my favorite Disney-Pixar cartoons. Not only does it have a cute story line, but it’s full of medical themes – consider the movie’s namesake with a congenitally deformed fin (Nemo), the shark with addiction problems (Bruce), and the blue tang fish with memory impairment (Dory). Even Nemo’s captor turns out to be a dentist! But when I think about the scene where the fish attempt escape from the dentist’s tank by plugging up the filter system to get him to remove them for cleaning, I always think about kidneys. Yep, you heard me right. Kidneys.

Kidneys are fairly under appreciated organs. They filter waste out of 200 liters of blood each day, much the way a fish tank’s filter system purifies its water. Most of us probably don’t even notice a fish tank filter when we gaze at the plastic plants, pebbles, and colorful animals inside the tank – just as we don’t give our kidneys a second thought until they cause us problems.

But the reality is that an astonishing number of people will develop chronic kidney disease (CKD) in their lifetime, largely due to complications from diabetes. An estimated 26 million Americans have CKD, and the majority don’t even know it. Our fish tank filters are failing slowly – and the build up of “algae and grime” just doesn’t cause symptoms until very late in the failure process.

Since March is Kidney Awareness Month, I thought it would be a good time to reflect upon the hard work that our little guys are doing each day. Beyond filtering drugs and chemicals from the blood, kidneys balance body fluids and electrolytes, create Vitamin D, regulate our blood pressure, and produce hormones that stimulate our bodies to produce red blood cells. In fact, anemia can be one of the first signs of kidney failure, and may be experienced as generalized fatigue. People with CKD often suffer from anemia, which can be treated with dietary changes, oral iron, IV iron, or blood transfusions depending on disease severity.

So whether or not you’ve been feeling fatigued, why not ask your primary care physician to check your kidneys next time you’re there for a check up? A simple blood test can identify many kidney diseases early on – so that you can take steps to keep your filter system healthy for life. Just ask Nemo – being in a dirty fish tank is no way to live.

For more information about CKD and anemia, please check out this infographic:

Synthetic Blood Via Artificial Cells And Platelets From Stem Cells

There’s hema­tology news, times two (at least):

1. Progress in devel­oping syn­thetic red blood cells

A University of North Carolina-Chapel Hill research group has created hydrogel par­ticles that mimic the size, shape and flex­i­bility of red blood cells (RBCs). The researchers used PRINT® (Particle Replication in Non-wetting Templates) tech­nology to gen­erate the fake RBCs, which are said to have a rel­a­tively long half-life. The findings were reported on-line yes­terday in the Proceedings of the National Academy of Sciences (PNAS) (abstract available, sub­scription required for full text). According to a PR-ish but inter­esting post on Futurity, a website put forth by a con­sortium of major research uni­ver­sities, tests of the par­ticles’ ability to perform func­tions such as trans­porting oxygen or car­rying ther­a­peutic drugs have not yet been conducted.

Developing com­petent, arti­ficial RBCs is a hematologist’s holy grail of sorts, because with that you might alle­viate anemia without the risks of transfusion.

2. Progress in using human stem cells to gen­erate lots of platelets

In an exciting paper pub­lished today in Cell Research, inves­ti­gators stim­u­lated human embryonic stem cells to become platelet-producing cells, called megakary­ocytes. According to the article (open-text at Nature PG), the platelets were pro­duced in abun­dance, appeared typical and clotted appro­pri­ately in response to stimuli in vitro. The researchers injected them into mice, used high-speed video microscopy for imaging, and demon­strated that the stem cell-derived human platelets con­tributed to clot for­mation in mice, in vivo (i.e., they seem to work). Read more »

*This blog post was originally published at Medical Lessons*

Remembering Gene Goldwasser: Discoverer Of EPO, A Cure For Anemia In Dialysis Patients

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Gene Goldwasser died last week. He was 88, and he was my friend.

I wrote previously about a series of conversations I conducted with Gene and Rabbi A.J. Wolf a few years ago. I met Gene one spring day after calling to invite him to sit in on a class I was teaching to a small group of medical students about social issues in healthcare.

I’d read about him in a book called “The $800 Million Pill,” by Merrill Goozner. In the book, Goozner writes the story of Gene’s two-decade hunt to isolate the hormone erythropoietin (EPO).

Part of the story relates how Gene tried to interest traditional big pharma companies in his discovery, only to be brushed aside. Instead, Gene wound up sharing his discovery with what became Amgen. The company went on to make a windfall from recombinant production of the hormone and licensing it as a drug for patients with anemia and kidney failure. Read more »

*This blog post was originally published at ACP Internist*

Computer Error: 25 Blood Tests Ordered On Same Patient

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It’s going to take a while to draw all those labs. And the patient will probably need a transfusion at the end of it.

(Reportedly the printer engaged itself in a loop and printed out blood culture label sets 25 times, so don’t panic).

*This blog post was originally published at GruntDoc*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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