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flow and good evening, epically Is that moment on a man? It's freaky, but I'm going to be doing the managing the chaps. Evening. Uh huh. And welcome to anatomy. Serious Week three. Covering renal and your ovary. That speaker this evening will be Doctor Hope Shower. This is the most medical photo of her. I could find that is not joined just yet, but I believe she is on her way, so I'm gonna give her a problem. It Sure she's coming. Um, someone already asked How many kidneys are? Interesting question Aleve it Every week I share this. Please, do you make the most session off, however, is best if you take notes if you want. Take notes. Helps put things in your memory. Do ask questions and I mean, really do ask questions we love to see them makes. Remember that you guys were awake, and if you enjoy any particular bit stupid, it's email us for results. It's We're more than happy to see them. Any queries? That's my email address. Uh, philosophy Instagram follow us. And Facebook. We're trying to promote these is best camp. Um, if you know, a part of it already are once month. Siris coming up. I think Tuesday we have office case discussion which were discussing a few clinical scenario cases. And so talking through what's going on with them within December of dying of palliative care session Ah, this where we are currently in this Siris next week. Gastrointestinal myself teaching it and then me doing your oh Josh coming back. It's a head, neck and ent, um, and was currently sorting out the anatomy. Serious parts, too, which will be in sort of February March time that with some more sessions So with that would be just quickly check where hope there's gotten to Uh huh practice has been put in as a guest. That's with Let me try and correct that second one second, guys. Sorry here. Some reason it's not allowing hope to join as a presenter. Good slide for this one, actually. Ever go made a slight for a reason. Uh huh. Yes, this is one. The big problems with this serious. It's just I do know, understand why, but it keeps breaking the tech she's joining now while she's joining. Let me also the one question is in the chest because I fancy answering it that someone asked How many kidneys are there? Actually, a bit variable, which is where most people are born with two leftie and righty. But then if you have a kidney transplant, you can actually go up. So I don't tend to actually take out old kidneys. That interest put the new one in a swell to some people that I've seen, patients had four. They have next relief side no to the work on to that. Didn't. Oh, there it is to be hope now to give her a second to get some sort of eso. Some people had four because they had an extra transplant on each side, and then we'll actually their case. I think three didn't work on one did that. Sometimes people have one removed. Yeah, I can see a hope. Uh, do you want to show your slides? Uh, let me share slights then. True. Any chest special we hear from filterable at this whole showing. Slight business, despite it being a year and a half into the pandemic. You know something 0, 10 days, so Oh, no, I've got them. I can see some That doesn't update very well. The only time we ever get, like a proper, like break down, honey, People attended is at the end when it gives me a report and it it's stupidity. I was answering this question about how many kidneys other it's invites having know, having a 10 trimwork me trying to chefs lines. I was going to leave my technical difficulty slide up. Yes, please was invented for Melanie on now. It works just but Well, I saw this out. Um, have a think first about hope. Well, don't be able to record the contents of the screen. Tinnitus. Quit, right, Freddy? I'm going to quit and rejoin a call. Oh, sure. For me. To your camera. We had her for a minute. Sorry. This is very yeah. Uh, every single university, every single hospital trust, every single Everyone always has trouble with Tec. I don't understand why it's not even like teams is complicated. It just seems to misbehave sometimes. I'm sorry to those that he joined Having trouble this Is there any more questions? Please feel free to ask them. I can answer questions in developed spirits. Good. Particularly interesting ones. Um, the kidneys. That tends to be too when you're born sometimes. No. But there should be two in your bone. No, that have hopes going to cover it. There's a thing called horseshoe kidney, which is where you're born with just one massive kidney. That sort of spans all the way around like a horseshoe. It's a weird congenital defect. It's Yeah, they're quite funky to see. Go who? Ah, there we go. We have hope. Slides. No, we don't. We just hope. Screen? Yes. Flights. Yeah. There we go. I could see, uh, there might even be my face. But that's not really what I can make that happen. No, I was doing the wrong thing. And like a grandma, this whole, this whole doctoring thing has aged me. So they didn't really mention much about hopes previous. That's the hope is a foundation your one doctor based in what? Now it's just may just lets a couple together. Hope this foundation your one doctor up in Watford. So, baby doctor, um, not Dr Off babies, but just a very new doctor also. Why is your so let me show your camera. There we go. That Yeah, don't don't bother with the camera. It's not that it's more important it'll So yes. Hello. You mind that with the protractor introduction? Thank you for coming along. Um, I hope will have some marginally interesting bits about kidneys on gas this slight a lute soon. I'm pretty sure you're no more than you think about kidneys. So, um, I'm hope I'm a newly qualified doctor. So I graduated last year, and I'm currently working. And what for a general hospital? Um, so scope of this is as a little anatomy as we can possibly get away with what kidneys actually do, which is a ridiculous amount, a little bit about how it goes wrong and how to fix it. And the point of this is not to be, you know, super comprehensive. And, um, you know, to tell you everything you need to know to pass, like, you know, a year and metsa know, nursing whatever. I appreciate you never had that so many healthcare courses that one can apply for, and hopefully this will be relevant to lots off them. Um, so to start where if you're going to the website below, um, which our quickly switched screens for bit posted it in the discussion yet and ever think about home. How do you know about kidneys? Like, you know, where Where does your kidney knowledge come from? And I try not to be a grand mal of this again. No. So you should be able to click. Um, you know, that we're going to try and go best fits you, whether it's from clinical experience or B that, you know, work experience, previous jobs. Um, you know, so on and so forth. Um, scientific reading, teaching stuff that you learned about in school or stuff that you're interested in and read about about personal experience. You know, yourself family, someone close to you. So I hope this works. If it doesn't, then put in the chat and Freddie of your Don't mind keeping an eye on a chat Now, be really helpful. So I give us 30 seconds. So just have a think have a click, have a play around. And if this technology doesn't work, then just put in a chance. I've clicked it. I don't know if we're not. It's appearing on your one, but that's not you. Change slide and yours updates on what you're monitoring. Okay, I'm going to stop it in 3 to 1 they're just on time and let's see responses. Ah huh. It's called. I close this. Um Okay, so it's three responses. That's that's all right. Uh, the lot so scientific reading, little bit of personal experience and some with more clinical experience. Uh, we're just good. So that's still a good range off, you know, ways to know about kidneys. Lovely. So this is what I've said. I hope that doesn't make you somewhat interested in kidneys. And, you know, the urinary tract beyond just plumbing. Although a lot of redness actually plumbing and contextualizing into what you already know, whether that's from personal experience, you know, reading and teaching and soft or clinical experience thinks that you're seeing in patients. It's not comprehensive is not a course. Guy is not a syllabus and nothing hopefully to profession specific, even though, you know, um, I've only seen met school and gone through, and I've only been a doctor, so hopefully this will be somewhat vaguely useful to us around, regardless of what you're going to, right? Um, kidney anatomy. I hate it. It's not very interesting to me. Know what's important thing. You need to know to be in shape organs right under the, um within. Protected by your lowest rips on your back when you cut them in her. This is what you get. If you have done, like, you know, dissection bits in school, you might have done that, too. Like lambs, kidney or something. Um, and the kidney is just full off blood blood supply. So blood vessels going to it. The blood vessels call around these tubes, which is basically a plumbing system where the pee pee comes out. So blood goes around, um, shoulders also so bits in this thing, which I'm not sure you can see my cursor, but the the 10 colored tubes going through the latter's of blood vessels and on that filtration and, you know, getting water and and salts and stuff, um, produces pee so very slightly over simplified and, you know, even GCS uh, biology. I think we'll have more determined that. I don't think that's super important right now. Like, you know, rich, rich electrolytes get filled out where I don't remember this in my day drop. Um, yeah, honestly, you learn it. You know, you're pretty learning at some point, but how much you remember. Don't fall So kidneys is a filtration system, lots of blood going in and SP that comes up and what do they do? Well, what Donte do you do? Lots. It's it's ridiculous. So there's fluids salt on, beeping the balance of that. So you're not too salty, although sometimes late at night. I don't feel that way, Um, and excreting all your waste product. So you know the stuff that comes out in P it comes up because your body doesn't need so much of it. Produces lots of hormones, particularly once involved in blood pressure control and red blood cell production. And that's a little bit off. Metabolic is ing vitamin D. So activates vitamin D in to inform that the body can use so lots of things is tiny little organs if you see them come, you know, in skilled a real person, they're quite small. But I think the pack a punch, um, so what can go wrong? Because I think that's where it gets interesting. So if you go back to the same page, just no. And I want you to think about when when you might start thinking about kidneys, when would you, um, you know I think I have a suspicion that the kidneys have gone room and you will see that in do coz. So we have a little bit more time now. Um, and it should be present. This is you be your free text. So have I think hi. I'm not I'm not sure about that, but Yeah, um, brainstorm Give us many responses as you want is fine to heckle, But, you know, it's fine to be creative. Just put s many What's freezers? Things that would make you think that something's gone off with the kidneys. Yeah, I'm going to give a little bit more. Keep on going. Keep on going s And many as you like. Okay, Cool. Thank you. Thank you. I'll try and scroll down, but that schooling sometimes gets funny. So, uh, what do you have? Dark colored urine, blood and urine. So yeah, things in under the kidneys produce urine. If something goes wrong with them than some, you know, signals that some things going a bit off of the kidneys. Incontinence? Yeah, maybe not kidneys, but maybe bladder in the downstream plumbing system. Uh, UTI, everyone's favorite. So infection little bucks and grow everywhere stones again. Stones can be and kidneys and the bladder or anywhere in between. So that can consider kidneys to go. Ah, urinary retention. Maybe not the kidneys problem because the other ones producing the urine, But it's more of a problem peeing it out. Uh, lower back pain. Your classic one. If anyone's ever had Harlow nephritis or stones, then I'm talking is the worst pain ever. Um, and, yes, I love that pain. Comes from something squeezing to a space that issued and, you know, have space full. Um, it's don't trying to squeeze through a small tube. Produces that pain from the squeezing home. Sure. Yeah, I'm not. Well, I guess if you were told that you have a horseshoe kidney damage, Okay. Do I need to do something about it in a kidney transplant again? I hope that as income is too much of a surprise that, you know, kidney experts might be involved. Um, hi. I hope you're meant pee, but I don't know about pie Sick and kidney pie road in, um, yes, that's all I can see. Uh, variety of things and a slight, um, difference in how healthcare systems are divided. Really? kidney. Doctors can either be doctor, doctor. So people do a lot with kidneys and heart, kidneys function and the urologists. We're not new religious, so if you are Oh, they're the ones who do of the structure. But they're surgeons by training. So I love the stones retention sometimes, um, incontinence also. Ah, the mail. You know, they make it involved, so that will fall under the specialty. And I'm in. This presentation is a little bit slanted to it's kidneys rather than, um, the downstream plumbing. But if you're once have specific questions asked, put them in a check, I'll see whether I can answer them. And if I can't, I'll see if I can point you to someone who can. So these are the stuff that I thought so I know I mentioned not peeing at all. But if you have ever been, you know, out on a hot day and not drunk enough water, you might notice that you're not peeing enough. Um, if you have had to take care of a baby, you know that, uh, you know, number of wet nappies. Is that a good surrogate? Measure off how much your baby's peeing? Um blood in a P. People mentioned that, um and I put when old of numbers are written on a blood test, which is a really common way in hospital or something like GPC surgery to prompt a minute ago. Um, is there something wrong to do? We need to do something about it. Um, now that I appreciate that it's not often that might not be something you encounter as much as a patient as compared to if you're working, you know, on the other, sightseeing, the blood test and going what do all these numbers mean? Yeah, that's a good, um, stops. Don't think about how were my active it, You know, our knowledge about kidneys and the reason I have divided it is acute kidney disease, acute kidney injury. So take a chronic kidney disease and this but in a middle about no fractures and nephrotic syndrome. I'm not going to talk about it much if that's all, um, I can't mention under a K, but I wouldn't talk to much about it because it's a bit. Is it tangling this The ways The divider is a bit convoluted and this, I think, know worth the time as much as the other two, which are much more common. Those are about that. If you really wanted to know about Nephrotic syndrome, um, so these things go wrong. These are, you know, when any off these can cause the presentation's that I talked about, um, and many. There's so many causes off kidneys being unhappy, so acute. Stress me, you know, it's a shot. Onset is common suddenly, and the injury refers, so you know its function being thrown off course. So I often have been explaining. It is something's consequent needs to be unhappy. I mean, to find out why. Um is largely divided into prerenal causes. So that's in a blood supply we can see from The diagram is a blood which goes to the lettuce that goes around the tubes. Um, so if there's a problem that is privy, know if there's a problem, the stuff off the kidney itself, So the tubes themselves. Um, that's a reasonable course, and we'll talk about that later. So don't worry. And if there's a plumbing problem, so in the big trip, going to the bladder and going to you know, the outside world, then that's a called post you know, there's just base of dividing. It is, um um it's not used to a classification system. So, period. No, this is when there's not enough blood flowing to your kidney. What's dry day with a marathon runner and drop there? Really, A lot of them can have acute kidney injury on 22 simple things to do is to ask yourself, Are they dry? You know, Have they been having lots of diarrhea? Have to just run the marathon have been not been drinking and eating for a couple of days because, you know, they have dementia they couldn't afford or that what I got cut off something, something like that in the history. So that's an expert. So take a history. You know, when you're if you're seeing a patient and you're in a position to assess them for the first time, then when you ask what is going on that concluye into what things might be affecting their kidneys, even thinking about kidneys. Yeah, um, people can have a transient come temporary kidney injury. Um, because of this are other things and might not affect them in a long term. But it is, and at least in the hospital setting is important to recognize that over that might be a problem. And preempt that instead of letting them dry up like a prune. Ms. No, I really appreciate it when you know the grand Mal comes out hospital and it's like in the drier than before. Uh, renal causes. Everyone gets really excited about it. So this is where you get them there fighters and the four sticks in German people start doing all along. That's a glomerular nephritis. And, um, it's interstitial. Nephritis is a bit. It's a little bit much from you have a very simple bring. So you think about this this long to which is going through the lattice off blood vessels. If this stuff off that tube gets damaged, so it's like you're having, um, holes holes in a horse pipe, then thinks that blood can leak through protein but should be staying in the body might leak through. So that's why two simple things to do the urine. Um, there's something you can do by the bedside in a GP surgery really quickly to look for protein and blood, and then you can offensive. But tests which, um, lots off auto immune. Um, Marcus also antibodies fancy exotic things which take, you know, 12 days or come back on. But that might clue you into some auto immune cause off, which is, you know, the body's own antibodies attacking the these tubes and causing, you know, punching holes in them. So, um, you know, pause. This is basically yeah, the stocking, which is the toots have developed a whole because off, you know, auto antibodies on something like that. Um, and so those things leaking out into the we that shouldn't be in the week that should be in the body like blood and protein, then post renal. This was also just in excuse shameless excuse to pose a cat's picture. Um, these are all your plumbing problems. So when people talked about urinary retention stones, all these can cause problems with their PPI backs up in the kidney because your kidney still beautifully turning out urine, but it can't flow anywhere. It can be peeing out because there's some blockage downstream. So to simple things again to do on the war to do by the bedside bladder scan. So that's a quick scan to see how much, Um, you know how much he's in a blender? Um, an ultrasound of the kidneys and basically the entire urinary tract, and that will help your look for any blockages better. It's a stone, whether you that you can see the kidneys are puffed up, you know, full off. We that can go anywhere, and that's what's causing the kidneys to be unhappy. So nice, Renny colors, um, one your kidneys and go really quietly, And you might not know it until you know you do a blood test for some of the reason, and they come up in horrible with horrible numbers. Um, or you might have been a blood in the restored infection, blah, blah, blah, suffering that so cereal causes. Each of them has really, really simple things you can do. Um, if that's not enough blood going to the kidneys, then it's so find out. Are they dry? And why are they dry if it's the it is blood and protein coming out in the read and some things attacking the kidneys themselves. Then you can dip the urine and send for some exotic blood tests. Um, and if it's a downstream problem, they can do a bladder scan. See, how much is there in the bladder? Other in retention. And do an ultrasound of the entire system. See whether you're there, any stones blocking something off somewhere. So it is acute kidney injury stuff, And he's had a really simple things that, um, you know, you can you can do for patients. Oh, you know, someone else you can recommend that someone else needs to do for your patients? No. Chronic kidney disease is, um is the next next off big thing? Um, it's really, really common it. Come it asymptomatic. So, you know, people can live with, um, kidneys, which gradually get less robust as they grow old, and part of that is normal. Part of that might be accelerated by several, um, causes. So the most common cause is I've put here, Um, first on the left is high BP. So is, you know, just the pressure on the system going through the kidneys stresses them out. Basically, um, then this one in the middle is diabetes again. Really, really common. And the one on the right is polycystic. Kidney disease is fairly common. A resident I was communist the other two, but that can be a symptomatic for, you know, years and years until the kidneys just go off. So, um, hum, These kinds of things often discover on blood tests, um, and that a certain specifications. So one is G f s. So it's an estimate of home whole. Well, the kidneys are filtering stuff, and there's one called creatinine, which is basically a waste product, um, related to your muscle bulk. And when we talked about, you know, kidneys, influence, being in charge of excreting lots of race products. But that's one of them that can build up Your kidneys are not doing their drug properly. Then, um, how it effects and your other complications. Well, it is, you know, simple. We have talked about the functions of the kidney. So in chronic kidney disease, especially in the really advanced age, it just means the audience functions country done properly. So, um, kidneys controlled assault and electrolytes. In general, if the kidneys go off and they go off a lot, then you can have lots of buildup off electrolytes. So things like potassium we worry about, because that can make your heart to go in funny rhythms. Um, the waste products. Um, that the kidneys do. If that goes off that again, lots of things can build up, including potassium. We've talked about fluid can build up. So, uh, when people have water on the lungs Pommery a Dema, then one of the things in cause it is kidney failure, um, sometimes uric acid and can build up, and that makes you put it all over. And that's terrible on, um, metabolic. So the junk breakdown products of various drugs can build up. And that means that we have to be really careful when we give when we know that someone's kidneys are really off and we are giving them medic medications. So, um, follows of things you might do, um, a lower dose or spread it out over the day just so that the kidneys have a chance to excrete that, Um and, um, it doesn't build up the horrible levels. Um, that sounds about the hormones. So the kidneys produce, um, every three point in people, which that's your red blood cell production. If the kidneys go off, then the red blood cell production goes off, and then you end up getting anemia. So, you know, low hemoglobin know a lot of red blood cells. Um, the kidneys help to control BP as well. If those go off quite often, you get high BP and that that doesn't respond to the usual BP medications. So they run people that run at a high BP for a long time, and they might end up being on quite a few BP medications in an attempt to bring it down to a in a better level. And then, um, metabolic is, um so the kidneys activate your vitamin D. It can activate the vitamin deed, and that affects the bone health. So that's not good for the bones. And, um, people were in six renal failure. So when their kidneys are really not functioning much, um often will have to have a knack to Vater form of vitamin D, which is different from the vitamin D that you get from the supplements are from, you know, ex cheese, dark leafy greens and sunshine, um, so kind of kidney disease. It can come and really insidiously caused by lots of really common things. And it can cause some troubles all over the body. Although I should mention that I love. These are usually not a problem if you know it zone proportional to how well the kidneys work. So, um, people who are, you know, a bit older and have diabetes for, you know past 50 years they may have chronic kidney disease, but they might not have all these other problems off the electrolyte imbalance and fluid overload and anemia. So this well said it's a symptomatic caused by high BP, diabetes or politics. Cystic kidneys, although you know more causes exist and it affects the whole body, there's the kidneys affect the whole body. Then, um, so moving on from what can neck or the kidneys of a long, a long time somebody's the kidneys can become so naked that they have the problems that we talked about. The salt put anemia, BP, bottom Indy. So there's lots of ways to come by time. None of these really, um, under seem as having fresh new kidneys. Even transplants aren't quite the same, but, um, it doesn't give, you know, give time to people, and sometimes that can give them quite a substantial many more years off a good quality of life and let them do more stuff off their life instead off, um, his own, um, well, managing medications. Although sometimes that's also an option. So going from left to run, it's less dialysis. So that's, um when the kidneys replacing the kidneys job with an external thing. So using a filter outside the body are inside the body's the peritoneum. Richest will come the lining off the abdomen. Um, using that as a filter transplants, which you know, putting putting a new kidney in, um to replace to basically do the job off the neck and one. And then there's always conservative management. So, um, these two Dallas is, and transplants are quite stressful on the body. In It's although, you know the neck and kidneys affect the whole body. But it's only them needs people to have some, um, to be functioning a minimum level, to be able to breath stand his dialysis or transplant because, you know, once a big operation and one causes a lot of fluid shifts. And funny things were BP. If they're, you know, old or have a lot of other things going on, and the body might not be able to burst, and on these these two things dialysis or transplant, then conservative management that means, you know, using medications and mainly medications actually to control symptoms. Then that's an entirely really option. That might be the best way in in the best interests. Um, um, to manage the the end stage. Renal failure. Um, Little little bit about dialysis. I'm not a huge expert on it. Um, but basically, this is about dialysis machine looks like and the there's, um, human analysis and peritoneal dialysis, which are too big. But switch again. It's. And depending on where you work, you might not need to know huge amounts about but human dialysis. So that's using taking blood out, filtering it so a filter and putting it back in for that. And it's a form off access, which by which I mean it's like cannula, but in it. So it's a place in the body where basically, against stick a needle in, take lots of blood out, put lots of blood back. So this is think office Tiller. That's, um, is adjoining between artery and vein and most often in the arm. And, you know that needs special vascular surgery to do it. It takes a while. Also the mature and be usable. And, um, you can feel it if you're If you happen to, you know, know someone come into contact with someone, you can feel it because it feel like a little vibrating through. Um um, it is quite interesting. And if it bleeds, it can be a major bleed because there's an artery. Well, it gets arterial blood supply. So, um one this is called off the slice, but 11 way off, Um, dealing with a a bleed from a fistula. So you know, their skin breaks and it's that's holding up blood is to put a bottle cap. So one of those, like solid plastic bottle caps with the hollow end on over the fistula and press it as hard as you can, so that kind of helps it contained of the end. It's the same principle as any other major believe put pressure, and it started bleeding long enough for someone to repair it properly. Um, that's ah site note. Slight tender in. So there's a fistula in this picture here and on the right. That's the machine for peritoneal dialysis. So it is lots off fluid. A special fluid card dollars site, which goes into the abdominal cavity and use is basically the body's own, um, membranes. As I felt, I think it's quite it's quite interesting is quite were to think about, Um, basically, that's a whole meeting. Filter was us. Eso got shop bottom ones where these humor down, it's his machines. So, um, if you again, you know, come across the patients they don't know too much about, But it's a I'm having dialysis. These are some common, like basic questions that any non specialist can ask and your document. So sites of access by which I mean, you know, it's a fistula. Is it a tunnel catheter? Hickman line Last cath lab over. Even if you don't do anything about that, um, you know, if it becomes a problem later on, then it's good to know where these things on the body, um then finding out how many times a week to have dialysis where they have it. So I didn't really think about this until I started working because, you know, in hospital, you can't You can't necessarily see the notes off. Um, other trust. So knowing which consultant and where they have their dialysis. And basically, who knows this patient's should you need to contact them is quite useful. Onda. Have you missed any sessions? Because people who are on dialysis often did they arrested euro? Just the remnants of kidney function. So all of the problems that we talked about fluids, electrolytes, um, anemia, BP, vitamin D but meaning fluid electrolytes because those in kill you first, um, can become a problem of the MS lots of sessions. Now there's enough about dialysis. No, about a scan or just quickly make one comment with the dialysis one. Yeah, that's if if you come across especially early in training or before going to university, whatever. If you come across someone and they say they've got a fistula, touch it. Ask them if you can, like, put your hands on it and get the idea of what it feels like because it's it doesn't feel like anything else occurring in the body. Yeah, and it's really, really useful to have an idea of what a healthy and functioning fistula looks like. It feels like, because then if you come across one that's not healthy and functioning properly, you have something to compare back to, um that's one of the big things we were told in my second year of unique was just always touch fistulas If you get the challenge, is obviously with with patients permission Yeah, I'm It's like a slight tendency for after this, patients have lost in lots of contact with Felker. You know, their veteran's have been in hospital have seen specialists, then lots of time in clinics. Some of them can be really good teachers. So if they let you and they're willing to spend time with you, you know, depending on you know what capacity you're approaching them in. Then you know they can teach you lots about basically, how do you live with it? Because I can tell you all the things about the signs of it, but living with it is a completely different thing. So, yeah, if if someone you know you can encounter someone there for fistula and they let you touch it, you know, go for it because the way it feels where it is in the body. Um, Mr, getting a sense of what's normal in these patients is is really useful when you're later encounter them. When it's not normal, and they're ill. Yeah, that that's a good point. Um, misbehavior. I see you is basically when the fluid and electrolyte imbalance just completely goes off the skills. So, um, they're female filtration, which is I don't completely understand it, but I take it to be like a turbocharge. Um, dialysis is basically the allis. This isn't it, Um, and you do it when you've had a good crack in treating, you know, someone with all of these problems. So I'll read them out in a list later. Um, you've had a good crack that shooting them, and they still want to get better. So if they're acidic, because kidneys control off the, um, acid based balance electrolytes. So you know, potassium, especially. There's a big ticket items If that's keeps getting high. Despite all the things that you try to lower it and common sense, good, sensible stuff, then you might consider calling them. But intoxication. I mean, if there's a clear cause, whether kidneys going off so thinking things like, um, aspirin on lithium, then you might consider I see you because that's ah, you know, that's a reversible cause. If there's fluid overload and you can get on top of it by making them pee out the fluid. Because the kidneys are so naked, you might call them and you re may have put in brackets because even though, um, people like to teach it at least in med school day, and it comes, like, drill that into us. But clinically is fairly rare, at least compared to the other things. But you know too much your s. It builds up kind of fact the brain and it just, you know, throws off the brain. Um, then that might be a consideration for ice you and chemo filtration. Hence the coffee filter, um, so renal replacement therapy that, uh, a surprising variety of ways to do it. You can have dialysis, and that's using either artificial filter. So he model. This is a home maid filter. So peritoneal dialysis. It can be by transplants, which is working a new one in um, although even that comes with a lot of lifelong changes. So immunosuppressants drugstores the dump and down the immune system so that the body called accepts another human being's kidney. Um, and there's always conservative management, so that's using medications to do to control symptoms instead of treating the root cause, are filtering the blood because both one and two are both really stressed. One, the body and sometimes people's bodies on too frail toe. You know, they don't have the reserve take in other stressors like dialysis. Um, so we know replacement. There be only biased time. They're still increased mortality with it, you know, even even by being on it. And but, you know, the sometimes that time is enough. So, um, waffle on about a lot of stuff stopped. I didn't talk about any of the cancers. Um, infections. I know someone mentioned UTI. I'm sorry. Didn't talk about it. Um, stones. I'm didn't mention it over. I can't mention in the post renal causes. I'm sure that's more. And, you know, I'm sure you can think about stuff, um, that you want to know about kidneys and urinary tract. And as Freddie said, you know this many channels, So to us, questions be curious. Try and find out more. Um, these are kind of resources are quite like, but again, I'm aware of this. Quite It's quite medicine centric. So, like, surgery stuff and urology. If you're dying to know about stones and the stuff that people can do with your frosting, Mies and JJ stents and other fancy words like that. Teach me surgery dot com is really good. Um, I think it needs a love. It's about a K, um, which I think is really quite interesting. Ah, you know, dropped handbook. If you're really interested in medications, prescribing dose is metabolic SSM pharmacy type stuff, then you might find that interesting to read. Um, I put the diabetes, these two diabetes websites there. Quite good. Um, anything there? There's some compeition facing literature. So if you're trying to explain it to someone, um, the news on, you know, fairly good resource is, um and that's it. So thank you for listening. Think you're sticking around? Um, Also growing bit more for questions and heckling and questions that probably can't answer. But, um, yeah, I will. I'll leave this up. Well, such more video on. I'm not sure how all that works. I'll say that hope is truly rare among medics for the fact that she can actually get a session done like on time. People are. Yeah, you put your video has now appeared. Uh huh. Says a question on here that was asked during that. That is, how much urine do you know we expect in a bladder scan? What's normal? What's abnormal? Um, so ah, and I'll trust a post void. That means you're on some type A B, and then your scan them after we as 400 mils. So if you're you know, you think about it. Though it's 80% of a pint glass. That's quite a lot to have in your bladder. I think I was taught this might be here. Say that about 100 militants start feeling the urge. So, um yeah, it, um the short answer is below 400 missiles, even lesson That should be what you're aiming for. Obviously, you know, people can whole called their bladder for a long time. Sometimes people get chronic, um, retention so they don't. When impeded, don't pee out all the Peter's in the bladder. And they might have larger volumes in the bladder. Um, but you know, if it's 100 minutes or less, it can be fairly confident that they Peter all the pita that there is, and retention is not problem for them. So hopefully it's not post renal cancer, the kidneys going off everything about a case like I didn't have a patient today. So I think the max that most that is gonna set of use go to is like 999 mils anyway. And at that points, they're definitely, um, attention. A lot of them got, like, 750 then just say greater than or greater than 900 greater than one leader. If there's more. Yeah, At that point, if you're like, Oh, um, yeah, there's a bit too much pee. And, uh, yeah, that's taking tubes in place us to try and get some of that pee out. But it's also a good thing to think about the patient you're looking at with it. Now you're saying there was some people not have chronic retention they might hold onto. There were very long time, but then simultaneously, some patients Well, you know, the patients just been to the toilet and you're scanning them and they have nothing in there. It'll that makes sense. But if they've just been to the toilet and they're coming back and they've got a reasonable amount like 303 150 left, they probably really shouldn't have that much retained. Yeah, um, I can't believe I didn't put this in my slides because they've been there. It's in all my teachings lights, but the trend met us more than a number. So you know s with Bella's scans. As if literally anything else. Um, the trend is more important. Um, so some people I have a funny baseline off, you know, creating an e jafar, Whatever. Um and that is going slightly off point. So I've got undistracted now. Well, yeah. There's a brilliant quote written on the wall. I just finished. Cardiology is a block on on the written on the wall of the junior doctor's office. The cardiology was the only part of it so that the heart's only function is to pump blood to the kidneys because one of the kidney consultants got in and began writing on the wall. Previously had previously had a quote, which was something like cardiologists. Uh, cardiologists just really want to be renal doctors. Will some of this urologists three idea being that the heart is just really er on in the chain from the kidneys, and you're just a long way off getting to where you want to be as a kidney doctor. Yeah. Um, also, because cardiologists a so lots of things in the heart failure like to give make people pee after fluid that your heart is not pumping. And obviously that sets off the kidneys. Miss Kidney Stone like that necessarily. So if you have both your heart and the kidneys go off, then. Uh, well, not good luck, but it's tricky. Yes, the kidneys. Uh, so the kidneys, heart and lungs tend to be total. The three most three organs were trying to balance the most, I think. Yeah. Don't tell the gastro people don't have gastro. Don't tell hepatology. Oh, ology the three. You basically need to live well, other than the brain brain's always useful. Any other questions? Heckling commends, Um, just in general news articles or means saying nothing. At the moment, I've shared the feedback link in the chat. As always, we really appreciate feedback comb. It's really useful for us, particularly junior doctors like hope. It's a really good way for them to demonstrate that they have taught sessions. It's a good way for them to show that they've improved teaching sessions over time. um, so yeah. Please. Please do. Um, Shit. Pleased to get some feedback because I see them all the area with that, um on. Please do. Yeah. Is is Well, um, kidneys is no one's favorite thing other than the renal doctors because they're funny people. But it's one of the things that is so important. Every other area of medicine, No matter what you really do in medicine, it's so important. Everything in they see everyone except would be except for medics to paramedics. Much worry about urine. I could do all the older, older people coming in euros success supposed support urosepsis just being except the studio a urinary tract infection. Oh, you know, it's like, um, a lot of the dialysis patients who get some, you know, get an ambulance is coming from the dialysis center. Okay, I think as not everyone patients you get you get in touch with, you know, people are problems of the kidneys. Yeah, I think that you're very yeah. Everyone needs kidneys and kidneys. They're bored. Deborah cannot see any more questions. I'll give him another. Let's call it 60 seconds and then I'll course still got one Here. I see you is basically lungs, hearts and kidneys then, yeah. Uh ah. Do you get some specialty? I see you to do like brains. Yeah, but even then, the brain stuff is to keep is acute lungs, heart and kidneys like ticket electoral. You a, uh the more medicine I know, the more I believe that the urologists all right. And then it'll just comes down to kidneys. Um, but yeah. Brains, brain, heart, lungs, kidneys, Basically everything. You doing this? You know, my nose, To be honest, unless you're in a specialty in your Oh, I see you. Because then you get some just brains, and then also you get like, uh huh, where I am. So, Thomas, is that a special intestinal failure team, which they're like very, very sick patients because of their gut. Like they can't absorb anything from their gut. Uh, liver is that just affects the heart, lungs and kidneys in it. It does have a know. Yes. Well, hypokalemia is like you worry about it because it makes your heart school. Or it means they can't the Congo Look after that, uh, heart, lungs, kidneys anymore. Um, yeah, yeah. Okay. There's so there's no more questions. Like two seconds to react to that in case it was typing. Nothing more. Okay, Doky. Well, thank you, everyone showing up tonight. That was a very brief, very brisk session from Doctor Hopes Ovary. Thank you very much. Hope you're teaching the ceiling. And I said anyone who's got feedback pleased to share it. We can I will send around the feedback of our email as well, Because that seemed to work quite well last week for getting Yeah, you know, remember reminding people that we do. We do like their feedback. Um, other than that. Thank you, Doctor. Hope and thank you. Everybody see all four. So I think we got so I got cheese. They haven't, actually. Sorry. Let me just remember where I am Tuesday, 16th. Yes. We have one of our We have one of our once a month syriza on Tuesday. For those of you interested, you get the email about that from me, probably on Monday on. But then we're back on Thursday as well. For myself with gastro, which everyone's gonna think doesn't really matter anymore. There's all heart, lungs and kidneys make. It's also think that's all hearts, lungs and kidneys. Yeah, it was two. This is lost passing comments that there's when will doctor hope be back? I'll make you do more. You can't escape May if you want to do a session about pain. Yes. Actually, yes, I would be. Really good session. All right. I'll go talk to you a bit about pain. Um, no. Yeah. I'm not just saying this because of herself. Slight. All ready to go. Yes. No pain will be a very good session on. I've got time. So, actually, where that might fit quite nicely. We'll speak to you on then. Paramedics care when it's spilt all over their feet. I'm assuming that's regarding urine. Yeah, uh, tip everyone. Clean your boots when you knew when you kneel on the carpet and floor like a soft furnishing. No, no, never. Great. All right, Well, thank you dot Hope. Thank you, everybody in this session there. Thanks. Bye.