TWS - Hiking, Berger's Disease, and Dungeons

📝 Rx

Hi friends,

Been a second, got caught up with vacation and midsem exams. I'm also writing this weeks post from somewhere above the Indian Ocean lul. Got to see my family for break so now I'm flying back to Aussie land. I've been trying to do some school work but the Wi-Fi isn't having it, and honestly being productive on a place is super uncomfortable.

Life update so far is that I've been prioritizing the little time I have left in Brisbane as much as possible to enjoy the city, while trying to balance out STEP studying. Two years of med here have passed by super quick and it's surprising how many activities you end up leaving till the end because its very easy to get caught up on the day to day. Reason why this post is called hiking is because that's exactly what I've been up to with some of my mates. I've gotten very close to a few non-American students here and they won't be doing phase 2 with me in Louisiana so hiking around has been a nice way to spend some high value time together and get to see more of Australia, two birds one stone.

Besides that, OSCEs are coming up now (aka simulated patient exams) and that's slowly taking priority for the next few weeks as my main stressor 🙂

🩻 Diagnosis of the Week:

IgA Nephropathy (Aka Berger's Disease)

What is it:

This is the most common reason for adults to get bloody urine. To give a bit of background, the kidneys are basically filters for the body's blood, so they will process everything through these tiny mini-filters called "glomeruli" of which there are thousands. The glomeruli let the fluid part of the blood leak through into the urine but not any cells or big molecules and this is very important because we don't want to pee out our cells, our body works very hard to make them.

In IgA Nephropathy what happens is actually in the name of the condition, you have a massive amount of IgA in the blood and because the glomeruli filter everything, they get bombarded with IgA and damaged. What happens when you damage a filter and open up little holes everywhere? Stuff ends up going through the filter, in this case red blood cells, and so you get bloody urine.

What is the IgA? Well, it's an "immunoglobulin" and our body uses different types to fight off infections. IgA is specifically used in mucous areas (think intestines, lungs, and sinuses). When you get an infection in these areas, the body starts to make more IgA to fight it off. Normally the kidneys can handle IgA just fine, but in this case the body wrongly makes too much, and this ends up damaging the kidneys. It makes sense then that people who have IgA nephropathy either currently have an infection or just finished having one. Usually the bloody urine is just temporary but there can be a lot of variability in the severity.

Key signs:

Can be completely asymptomatic (urine can superficially look completely normal, but if examined closely cells would be seen)
Bloody urine positive for red blood cells (reason why most people come in)
Weak fever
Flank pain (from kidneys hurting, think bilateral middle back area)
Respiratory or GI infection (can be a current infection or one a few weeks back)

🤓 Dose of the Week

Books Read: 4

The Lazy Dungeon Master Volumes 1-4 - Title gives it away but basically this guy gets teleported to be the dungeon master in another world. Thing is, all he wants to do is sleep, so he actually ends up working very hard just to make sure adventurers and other people leave him alone. The level of ingenuity and effort that he goes through just so he can relax all day is 10/10 entertainment.

Hikes completed so far: 2

Twin Falls Circuit in Springbrook National Park: This was by far the easiest and honestly my favorite, the whole loop takes you through two waterfalls, then to the top of one of them for a scenic lookoutpoint.
Mount Ngungun Summit in Glasshouse Mountains National Park: Surprisingly fast walk to the peak of the mountain, it's like an endless stairmaster in the beginning but gets better. The peak has crazy views of all the other Glass House Mountain chain.