It’s #ExpBio Time Again!

It’s that time of year when all sorts of scientists head to Experimental Biology, this year in San Diego. I will once again be blogging the meeting, so cool cutting-edge kidney science will decorate these pages over the next week.

I’ve been planning my packing for a few days, including my electronic gizmos, cool shoes (of course), and background material for some of the studies. Friends will be there, and you can hear more details about scientists behaving badly in my twitter feed (@PHLane).

Yesterday I got a pre-meeting manicure. Don’t think of it as primping; its sharpening my claws for the wild world of science, even if the color does have the name Pinky Swear.

Go Kidneys!

No Mystery Here

As long as I can remember, I loved science. My copy of All About Dinosaurs suffered frequent readings. I went through a rock and mineral phase that I’m sure dismayed my parents. Finally I found biology, and eventually I picked medicine as a career option.

I also loved to read. For my elementary school years, publication of a new Nancy Drew book was cause for major celebration. When I ran out of her adventures, I tackled my brother’s Hardy Boys. Eventually, I graduated to Agatha Christy and other classic mysteries. I read a wide variety of things, but of the more than 400 books in my Kindle library, well over half involve solving crime.

Medicine, science, and mysteries involve many of the same processes. In all three, there is a problem to be solved. In medicine, we want to know what’s wrong with the patient. In science, we need to understand a phenomenon. In a mystery, we want to know whodunit. In all these fields, we collect information to help us first: a history and physical, a literature review, and looking for clues. In each area, we then formulate a hypothesis. In medicine, it’s a differential diagnosis. In science, it’s actually called a hypothesis. In a mystery, suspects are assembled and assessed for means, motive, and opportunity. Finally, any hypothesis has to be tested. In medicine, we run tests or try a treatment. In science, experiments get performed. In the world of crime, evidence gets accumulated until there is proof that someone did it and/or they confess. The results can thenI be examined to see if we accept our diagnosis/hypothesis/result or if we have to rethink everything again.

I’ve written a lot of biomedical papers and a handbook for academic medical faculty. I began blogging to communicate about science and found I loved writing in this less formal way. Now I’m exploring the world of fiction, especially trying to put together mysteries. I’ve perhaps come full circle.

Treading Water

Blogging used to be a habit, something I did.

Needless to say, I am out of the habit.

Lately I have been writing but not blogging. I signed up for a wonderful course, a do-it-yourself MFA. Oh sure, a lot of it could be learned by reading the book of the same title. But paying for the course gives me

  • motivation to get my money’s worth out of it
  • writing peers
  • an interactive experience

I find this relaxing (I have a day job, so no financial pressure to get that draft done), and the process has taught me a lot. No one will give me a bad grade for not keeping up with the class, either.

As I write, I realize that this site will change. What has been primarily a source of information about kidneys with a pediatric focus will now include other stuff. I may start pitching that children’s book about my cat with kidney disease again. I may post bits and pieces of other works here.

I hope you go along with me for the ride. It should be fun. And I hope I get around to putting a few more words on the internet!

Best Practices May Not Be

Another writing prompt today asked about so-called best practices for writing that have failed epically when I have tried them.

My biggest failure was the year I tried to do NaNoWriMo. In November each year a whole bunch of people sign up for National Novel Writing Month, pledging to write 50,000 words (the length of a short novel) during that month. I knew this was not a good time for me. I travel to two national meetings in November (although that airport time should be a bonus), and there are these holidays at the end of the month. Nevertheless, I gave it a shot. I was going well until about 5,000 words into it. It was time to write something about the antagonist, and I knew immediately it was bad. The earlier bits about the protagonist and her world, based on things I knew well, came easily. I needed to learn more about the villain(s) before I could write about them.

The idea of grinding out a first draft of crap is fine. I’ve done that a lot with scientific writing. In this case, the need for further research became crystal clear, and I started in on that. I’ve also started a different project where the antagonist is in a more familiar world. I’m hoping I can get my feet wet with this one and go back to my NaNoWriMo project when I understand my villains better (although that may take some time).

I’ve since met people who have written and published novels drafted in a November frenzy. It just didn’t work out for me this time.

Reality Demands It Be Honored

I signed up for a bookclub with writing prompts recently to get back in the habit of writing for myself. The newest prompt really hits the target:

Prompt: Tell a story about a time when you had to honor your reality.

Sometimes life gets in the way of writing, which pretty much describes the past two years. In January 2016, my husband started acting weird enough that work colleagues noticed. I had seen some subtler issues for a couple of months, but of course, he would not go to the doctor. When the department chair said he needed medical attention, he got medical attention.

We found a grapefruit sized brain tumor.

For the past two years, my posts have been few and irregular. Some have been updates about my spouse, and occasionally I have pulled off a real post. I have been scribbling in a journal on a more regular basis, but that is really digital screaming, not writing I would share without a great deal of editing.

Treatment has not worked well with this cancer, and Jim had to enter a nursing home last September. As I faced the inevitable conclusion to his journey, I realized that I wanted to write for me again.

And here we are.

Sometimes your reality means you miss a scheduled post. Sometimes it means you dwindle for a couple of years. Either way, reality demands it be honored.

Thank you to DIYMFA for providing so many resources to get me back on track.

Past, Present, and Future

I always loved to write. I remember creating “newspapers” in my room after I got a typewriter, and I spent a lot of time working on the yearbook and newspaper for my high school. My love of writing kept me going in research, even when the experiments did not turn out as planned. Over time, I have found joy in non-scientific writing. I got to help create a magazine and write a handbook.

One could see my biomedical career as a response to my childhood reading habits. I explored books about science and biographies of famous people in science and medicine. My other love was mysteries. What is a hypothesis or a diagnosis but a mystery? In every case, the reader wants, no, needs, to figure out what happened and why. I dabbled in other genres, but I always returned to mysteries, even after I outgrew Nancy Drew.

Now I want to write fiction. and I really want to create my own mysteries. I am exploring possible characters and scenarios. I need to post these from time to time to get feedback and have the fun of others reading my words.

I will still write about kidney science and nephrology. I hope you enjoy the ride as I explore my creative side.

Why I Haven’t Been Here

My new offspring!
My new offspring!

Wow. I have not posted here since August. I do have a pretty good reason, though. I wrote a book!

One of my interest is faculty development. We are good at training doctors, but they often do not have the skills (or knowledge of what they need) to succeed as a faculty member in a College of Medicine. After advising folks for several years, developing content, and hanging out with others who have similar interests, I decided to set all that wisdom down.

Yes, it’s a book for a small niche market, and it’s only about 10,000 words. It’s still a book, and holding it makes me feel more published than any paper I have put out in the scientific literature!

Learn more about The Promotion Game: Your Guide to Success in the Academic Medical Center at the website.

Fun Fact: Videos Available

I am in the process of converting a number of lectures to short videos. These are directed at pediatric residents (doctors who have completed medical school and are learning this specialty), but most can be understood by laypeople as well.

Sure, you will find some weird random stuff on my YouTube channel, like video tours of my new landscaping and presentations on other topics. Perhaps you will enjoy these as well, who knows?

The first topic I have updated is acute kidney injury, what we used to call acute kidney failure. You can see the video by clicking here or watching below:

A-List Kidney Problem

Blood in the urine (hematuria) occurs in 10% of children on occasion. It may be microscopic, detected only with a dipstick or high magnification. It may be gross, with urine that looks like cola, red wine, or cherry Kool Aid. Sometimes kids have microscopic hematuria with intermittent episodes of gross blood. These children often have IgA nephropathy (IgAN).

Many patients with IgAN suffer no symptoms and diagnosis requires kidney biopsy, so the exact incidence remains unknown. In the US, about 0.5 new cases per 100,000 children occur annually. In Japan, the incidence is 10-fold higher. No one knows the cause of IgAN, but we assume that the immune system lies at fault.

Glomerular Tuft: C=Capillary
Glomerular Tuft: C=Capillary

The diagnosis currently relies on the presence of IgA deposits in the glomeruli, the filtering units of the kidneys. A portion of a glomerulus (a tuft) is shown in the diagram. Blood flows through and gets filtered in the capillaries (red C’s). Epithelial cells surround the capillaries (orange arrow), while mesangial cells (blue arrow) fill the “stalk” region of the tuft.

Using special techniques we can see IgA in the mesangial region of the glomerulus in this disorder. There may also be extra cells in that area, known as mesangial proliferation.

The course of IgAN varies from limited progression (or even some episodes of spontaneous remission) to rapidly progressive kidney failure. Kidney function measurements guide management:

  • Estimated glomerular filtration rate (eGFR)
  • Blood pressure (BP)
  • Protein:Creatinine ratio (P:C)

Nephrologists reserve biopsy, an invasive procedure, for children with abnormalities of at least one of these measures of kidney function, or children with multiple episodes of gross hematuria. Usually patients need no treatment if all measures of kidney function are normal, other than annual observation.

Elevated BP requires treatment, usually with anti-angiotensin therapy (ACEIs or ARBs, in doctor-speak). These agents benefit the kidney beyond their ability to lower BP, especially with elevated P:C ratio. If the P:C is more than 1 mg/mg, then anti-angiotensin drugs should be given even if the BP is normal! After 6 months of therapy, if the P:C remains more than 1, then a 6-month course of steroids should be discussed. Fish oil may also be considered with persistent protein in the urine.

When the eGFR falls rapidly, often associated with crescents (a type of glomerular scar where epithelial cells multiply) on the biopsy, aggressive therapy with steroids and strong immunosuppressants (cyclophosphamide or azathioprine) may reverse the disorder. A number of other drugs can be used in IgAN, but none have proven benefit at this time.

The prognosis of IgAN depends on P:C, BP, and findings on the biopsy at diagnosis. If no high-risk abnormalities are present for these 3 factors, the 20-year survival without dialysis for both children and adults was 96%. If P:C>1, BP>95th percentile, and unfavorable biopsy findings were present, only 36% of patients maintained kidney function for 20 years.

Want more information?
N Engl J Med 2013:368:2402-14.  DOI:  10.1056/NEJMra1206793