Practicing Medical Skills in a Small Clinic

Chapter 465 - 222: Enlarged Kidneys That Aren’t Kidney Disease—A Physician’s Parental Heart

Don’t just talk about a single street; even a single department is a deep water.

Wherever there are people, there are conflicts, an eternal truth.

Li Jingsheng was able to integrate into this interest group and quickly gain such a high status, thanks to both ability and luck.

After the banquet ended, everyone went their separate ways.

A particularly interesting detail is that Boss Zhao always had a crush on Tang Ping, but he didn’t speak a word to her during the banquet, not even daring to look at her directly.

It’s unclear whether this was because the owner’s wife of Furuiduo Pharmacy was present, and he feared making her jealous, creating trouble.

Or possibly because he was wary of Li Jingsheng’s power and status.

In any case, Boss Zhao is a smart man, often especially cautious with risky matters.

Li Jingsheng drank a few glasses of wine, feeling slightly tipsy, but when he returned to the clinic, his mind was clearer than ever.

As he sat in the empty reception hall, his mind pondered over the difficult case Director Mu encountered.

The patient is a female under forty, described as an agricultural worker in the medical record.

It can be expected that this patient’s income is relatively low, and her education level is probably not high either.

Because, under normal circumstances, middle-aged people with even a slightly higher education level would mostly go to the city for work to improve their family income.

A month ago, the patient experienced pain in her right lower limb, reduced urine output, and noticeable swelling of her lower limb.

Later on, doctors from the Second Hospital confirmed that it wasn’t swelling, but edema appeared.

Oliguria, lower limb edema, and right lower limb pain, following normal diagnostic thought, the problem would first be locked onto the kidneys.

In fact, the initial appointment the patient made was indeed with the urology department of the Second Hospital.

Possibly due to financial constraints, she couldn’t bring herself to book with the department head, settling for a general outpatient appointment.

The attending doctor was Tan Shuilin, a young and promising doctor in the Second Hospital’s urology department.

This person is similar to Dr. Qin from the orthopedic department, both part of that outstanding category among resident doctors.

Ordinary resident doctors are not qualified to open outpatient appointments.

For instance, when Li Jingsheng just joined the Second Hospital, he could only work under Doctor Xu. Only a few days ago did Doctor Xu let him ’establish himself’ and separate for consultations.

Only then did the orthopedic department step in to help him apply for an outpatient physician number.

Although it seems like an insignificant thing, for a doctor, it is a big step forward.

Many resident doctors eagerly endure, and even if only offered a one-day-a-week outpatient opportunity, it’s cause for immense joy and anticipation.

Because the vast majority of doctors need to persist until they become attending physicians before having the chance to open outpatient numbers and formally qualify for consultations.

Just like in ancient times where local doctors, at least achieving the rank of physician, were qualified to consult.

At the very least, reaching the official rank is considered a proper local doctor.

This qualification requirement also exists today. Normally, a doctor needs to undergo one year of internship to graduate, then three years of standardized training and obtain a medical license to become a formal resident doctor.

Those wishing to consult need further effort, with a master’s degree holder needing to work formally for more than two years to take the attending exam.

Only by advancing to attending does one truly ’become like a doctor’.

After receiving this patient, Tan Shuilin was naturally cautious, ordering multiple checks and conducting a careful inquiry.

Fearing a misdiagnosis might happen.

Through careful examination, he found that not only the patient’s lower limbs were edematous, but two masses were also discovered in the abdominal area, specifically in the left and right waist areas.

Renal edema typically doesn’t swell so large.

Aware of the severity of the issue, Dr. Tan Shuilin became even more cautious.

Conducting a detailed inquiry into the patient’s symptoms, she described the pain beginning from the right waist and buttock, akin to being pricked by needles, extending to the back of the right thigh and all the way down to the calf.

The patient also exhibited decreased urine output, abdominal distention, lower limb edema, dizziness, fatigue, nausea, vomiting, and a series of other symptoms.

These symptoms subtly pointed towards severe kidney disease, such as uremia.

Measurements showed that the patient’s urine volume for the day was only about 500ml.

The patient had a body temperature of 37.8 degrees, indicating a noticeable mild fever.

Her systolic blood pressure was 190mmHg, and her diastolic pressure was 118mmHg.

For adults, normal blood pressure ranges with systolic blood pressure between 90-139mmHg, and diastolic pressure between 60-89mmHg. This is the ideal blood pressure range.

This female patient clearly showed signs of hypertension.

Since uremia patients exhibit hypertension and fever, Dr. Tan was even more convinced that the patient had renal failure combined with acute nephritis.

Abdominal ultrasound examination revealed the patient’s kidneys were enlarged.

This also confirmed that the masses found in the patient’s abdominal double waist position were due to kidney enlargement.

The kidney is somewhat like a sponge, with a very complex internal structure, primarily filtering liquids through the glomeruli, expelling toxins and excess water as urine, with the essential elements returning to the bloodstream.

This is why, in some heart disease cases, a urine routine test or even a kidney function test may be required.

This isn’t over-treatment; rather, it’s doctors suspecting kidney disease causing cardiac changes.

Dr. Tan Shuilin ordered routine blood, urine, and other checks for the patient.

Hemoglobin was 47g/l, white blood cell count was 5.7 x 10^9 per liter.

The lymphocyte ratio was about 0.35.

Platelets were at 89.

Urine protein quantitative was 0.26g/day, a 24-hour measure.

Urine specific gravity was 1.015, and blood urea nitrogen was 14.7mmol/l.

With all these findings, Dr. Tan Shuilin was fully confident that the patient had rapidly progressing nephritis and renal failure combined with polycystic kidney disease.

Thus, the patient was admitted for hospitalization and administered with diuretics, vasodilators, and infection management as part of a diversified treatment approach.