Week 5 - Mary

I just finished my fifth week of the summer immersion program at Weill Cornell, and it was a heavy research week. I continued segmenting CT and MRI scans to measure kidney, liver, and spleen volumes and spent a good chunk of time reviewing our list of ADPKD transplant patients to determine who met our study's inclusion criteria. The main bottleneck turned out to be imaging. Since we're interested in how kidney growth rate changes after transplantation, though, to be included in the retrospective review, a patient needs at least two CT or MRI scans, both before and after transplant, and before and after dialysis if applicable, to calculate that change.

Outside of research, I also shadowed Dr. Shimonov on one of his hospital service days, where I got to see him round with his fellow and residents across several different wings. What struck me was that this was a consulting service. In other words, the patients we saw hadn't been admitted for kidney issues at all, but had developed an electrolyte imbalance or related condition secondary to whatever brought them in. Most of the patients had hyponatremia, too little sodium relative to their body's water content, and were being managed with salt tablets. What I found interesting, though it makes sense once you think it through, is that they were also having their fluid intake restricted, since adding more water on top of already low sodium would only dilute it further. One patient stood out as the opposite case, hypernatremia, too much sodium relative to water, which needed the reverse approach. In both cases, dialysis becomes necessary when a patient's kidneys aren't functioning well enough to correct the imbalance through fluids or salt intake alone, so the team tries to manage electrolytes conservatively for as long as that's a safe option. Watching the reasoning behind each adjustment made me appreciate how much of this specialty comes down to timing.