Tag: books

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What books or resources should I use to learn nephrology?

I received this DM today (my DMs are open. I was nervous about opening DMs but a year later I would rate the experiment as a delightful success. It has opened up Twitter to many new discussions that otherwise would not have occurred).

Hi Dr. Topf, I’m a final year medical student from the UK. I’ve been following you for a while due to my interest in renal medicine. Are there any books/online resources that you would recommend to learn renal physiology? I feel that I lack fundamental principles and concepts which I’d like to improve. Thanks!

Arnav

This is actually a relatively common question and I am going to attempt to write this post so I can link to it in the future.

The answer depends on the goals of the student

Preclinical medical student.

Vander’s Renal Physiology

Slim, readable. Good choice.

The Acid-Base Haggadah

This is designed to be part of a workshop but it can be read on its own.

Medical student or resident on a clinical rotation

This list is for the learner who is looking to know what to do.

Nephrology Secrets

Of course I’m one of the authors and I edited every single word in this book but a year later I still am amazed at how well this review book walks the tightrope of being concise without over simplifying complex topics. I may be biased, but I think this is an excellent book.

NKF Nephrology Primer

Before Secrets this was my go to recommendation, but this book is getting long. I’m beginning to think this may be too long for a student resident on a one month nephrology rotation. That said you can’t find better renal educators that editors than Gilbert and Weiner.

The learner really wants (or needs) to have a mechanistic understanding of why we do what we do then…

Fluid, Electrolyte and Acid Base Companion

It is strange that one of the things I am most proud of in my entire career is a book I wrote as a resident but it is no exaggeration to say this book for transformative for my life. I poured five years of work into this project and i think it stands up. However you should skip the tremendously outdated and overly complex section on the treatment hyponatremia and instead read the European Clinical Practice Guidelines.

Burton Rose’s Clinical Physiology of Acid Base and Electrolyte Disorders.

People look at the copyright on Rose’s electrolyte book and conclude the book is out of date.
It is.
It doesn’t matter.
Rose excels at providing the reader a cohesive mental model of how the kidneys work so that things make sense. Then if you need to learn more and get a more up to date and nuanced view of how the kidney works it is pretty simple to plug those updates into your mental model of the kidney.

The nephrology fellow

Use the following:

  • Nephrology Secrets
  • Burton Rose’s electrolyte book
  • Daugirdas’ Handbook of Dialysis
  • All of the KDIGO clinical practice guidelines
  • A subscription to UpToDate
  • A subscription to Nature Reviews Nephrology
  • Attend every NephJC

Read the first three cover-to-cover and then cover-to-cover again. The KDIGO Guidelines will give you the state-of-the-art for many of the important issues in Nephrology and the full guidelines provide a solid scientific rational for why the guideline are the way they are. You should have more than a superficial familiarity with the guidelines. Use UpToDate and Nature Reviews to go deep on every weird, rare, or interesting patient. Use the last one to stay up to date with clinical research. That’ll do. That’ll do quite nicely.

What did I miss? What are your favorites. Hit me up on #MedTwitter or slide into my DMs.

Some good updates from Twitter

And Mir Tariq Ali reminded me of major omission to my list. I forgot Daugirdas’ Handbook of Dialysis. This is the third book that every nephrology fellow should read cover to cover and then read again.

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In defense of the epigraph

I was listening to the Slate Cultural Gabfest on my way to work this morning and Julia Turner asked the audience to defend the epigraph, the quotations that some authors use to lead off a book or chapter.

The Fluid and Electrolyte Companion used an epigraph that I thought was perfect and communicated the mood I wanted readers in as they read the book:

The quotation is from Dr. Strangelove and General Ripper (the man with the cigar) says it in the scene captured in the picture at the top of PBFluids.com. If you haven’t seen the movie you really should. It is one of Stanely Kubrick’s masterpieces and possibly the funniest movies I have ever seen.

What touched me was how similar I am to General Ripper. Here was a man who spent all of his time thinking about precious bodily fluids and every time he captured someone in his vacinity and started to explain how wonderful and important they are, the other person just got nervous, uncomfortable and wanted to squirm away. In the header picture, imagine me as General Ripper talking about pseudohyponatremia and imagine Group Captain Mandrake being played by an unsuspecting innocent medical student who is randomized to one of my medicine teams.

The mood I wanted to establish was that this text book was lighter than Guyton’s physiology, we would poke fun at medicine and you could unbutton the white coat and relax a little while reading this text. I think the epigraph absolutely nailed this mood.

By the way if you downloaded the book before this week, re-download it. I just added the leading 10 pages which include the introduction, dedication, colophon, table of contents and epigrpah.

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HeLa, Salk and the Tuskegee Institute

The Immortal Life of Henrietta Lacks is a multi-headed beast. The story is structured around three discernable plot lines. The first, is the history of the Lacks Family from slavery war up through present day. Another, is the author’s story of  how she met the family and uncovered the history. And the last leg is the history of science and how it relates to human cell culture and the HeLa cells.

This last story line is amazing, but I’m a little cooler to the other two. So far I’d say the third line is strong enough to justify reading the whole book but this is no The Checklist Manifesto.

One of the most interesting stories is regarding the first scientific win for the brand new science of human cell culture. HeLa cells were instrumental in the widespread testing of the Salk Polio vaccine. (All of the following excerpts from the book come from here)

“..in April 1952, [George] Gey and one of his colleagues from the NFIP* advisory committee –William Scherer, a young postdoctoral fellow from the University of Minnesota– tried infecting Henrietta’s cells with poliovirus. Within days they found that HeLa was, in fact, more susceptible to the virus than any cultured cells had ever been… they knew they’d found exactly what the NFIP was looking for”… “On Memorial Day 1952, Gey…sent Mary to the post office…When the package arrived in Minneapolis about four days later, Scherer put the cells in an incubator and they began to grow. It was the first time live cells had ever been successfully shipped in the mail.” …”When the NFIP heard the news that HeLa was susceptible to poliovirus and could grow in large quantities for little money, it immediately contracted Scherer to oversee development of a HeLa Distribution Center at the Tuskegee Institute… [p95] …it was the first-ever cell-production factory and it started with a single vial of HeLa that Gey had sent Scherer in their first shipping experiment, not long after Henrietta’s death. [p96]

George Gey was the original scientist who created the immortal HeLa cell line.
*NFIP was the  National Foundation for Infantile Paralysis, the organization now known as the March of Dimes, created by FDR to fight polio.

I had never known that the Tuskegee Institue had a role in the war on Polio and development of the Salk Vaccine. The HeLa cells were used in wide spread testing of the vaccine to make sure it was immunogenic. Since HeLa were able to be infected and killed by the Polio virus, they became a convenient means of testing the vaccine. The vaccine was administered to volunteers and six weeks later if that patient’s serum protected HeLa cells from Polio infection that alloquot of vaccine and its administration technique was immunogenic.

The only thing I knew of the Tuskegee Institute was its role in medicine’s most horrific racial crime, the studying of 400 African American men with syphillis without telling them they were infected or offerring treatment. This deception lasted for forty years. From Wikipedia:

By 1947 penicillin had become the standard treatment for syphilis. Choices might have included treating all syphilitic subjects and closing the study, or splitting off a control group for testing with penicillin. Instead, the Tuskegee scientists continued the study, withholding penicillin and information about it from the patients. In addition, scientists prevented participants from accessing syphilis treatment programs available to others in the area. The study continued, under numerous supervisors, until 1972, when a leak to the press resulted in its termination. Victims included numerous men who died of syphilis, wives who contracted the disease, and children born with congenital syphilis.[4]

So finding out that Tuskegee had a role in Polio was interesting, but discovering that the technicians and scientists in Tuskegee were all African American and that the Tuskegee institue had won the contract to produce the cultures in a form of proto-afirmative action blew my mind. An afirmative action program was happening at the same place, and at the same time, as one of the darkest moments in the mistreatment of African Americans.

…”Black scientists and technicians, many of them women, used cells from a black woman to help save the lives of millions of Americans, most of them white. And they did so on the same campus –and at the very same time– that state officials were conducting the infamous Tuskegee syphilis studies.