(The title? Sound it out. Get it? Eh?!)

I have spent the last two weeks learning about and discussing pee.

There are many different kinds of pee. Clear pee. Dark pee. Red pee. Orange pee. Foamy pee. Smelly pee. Oh, there’s more.

We’ve managed, in our accelerated curriculum, to jam the entire medical training for the kidney into two weeks’ worth of class. This includes both “What’s Supposed To Happen” and the “Oops! I Ruined My Kidney” versions of learning. (Unfortunately, our exam isn’t until the end of January — which means we have to hold on to all this information, somehow, for another six-plus weeks while we cover other stuff. But that’s a subject for another, more whiny post).

I am now afraid to take Advil.  Earlier in the year we covered acetaminophen poisoning, which happens if you drink alcohol and take Tylenol. So I was already scared off taking Tylenol if I’ve been in the vicinity of a Natty Light in the past two years; now pretty much all the over-the-counter painkillers are out. If I slip into oxycodone addiction, I can blame my renal unit. Good luck with future hangovers, everyone.

My key takeaway from the kidney stuff is that pretty much anything that can go wrong fulfills two criteria:

1. It is really bad;
2. It is definitely gross.

The nice thing about the different kinds of pee is that the problems associated with each are somewhat similar. Here is a nice flowchart I drew summarizing the problem.

There is no such thing as a not-scary kidney problem. Basically the most mild form of disease has a “risk of progression to end-stage renal disease.” ESRD is where both kidneys are ruined, to the point where you need a new one entirely. Or you spend four hours a day, three days a week, hooked up to a huge machine that looks like a Josef Mengele invention that cleans your blood for you. On days when you aren’t on dialysis, you sleep the whole time. No big.

If you drink alcohol, you can get ESRD. If you smoke, you can get ESRD. If you eat donuts or Oreos, you can get ESRD. If you enjoy life even halfway to the fullest, start looking for a donor.

I’ve mentioned in previous posts that we often rotate through pathology labs, where we see what diseased organs look like from autopsied or transplanted patients. Unlike any organ we’ve done so far, seeing some of the diseases that afflict the kidney is actively nausea-inducing.

In contrast, with heart disease you might see a very large, thick, or dilated organ. This just looks like a bigger hunk of meat than a normal heart, and you can joke about bigheartedness and love and etc without feeling like you’ll never order filet mignon (when your parents take you out to eat) ever again. Even with myocardial infarctions – a heart attack – the dead tissue just looks black, like someone broke open a Sharpie over the specimen.

The kidney is totally different. I’m actually not going to subject you to pictures, because that’s how gross it is. But since I know some of you readers are doctors and/or wannabe doctors and/or fascinated by train wrecks and/or (morbidly) sick-minded, there are links.

First, a normal kidney looks like this:

This is normal. It sort of looks like a bean, right? Nothing looks particularly gross or wrong. Normal.

The rest of the pictures are up to you. Click at your peril.

Some diseases you can get with the kidney are:

• Pyelonephritis: an infection of the kidney. Moderately gross.
• Malignant Hypertension: high blood pressure blows out the kidney like inflating a water balloon. Pretty gross.
• Kidney cancer (renal cell carcinoma): You won’t want lunch.
• Wilms’ tumor, an infant disease: Not good.
• Hydronephrosis: overpressurization of the kidney from a blockage “blows it out:” We’re in the homestretch…

My hands-down favorite Gross Kidney Thing deserves special mention: polycystic kidney disease.

We had this one in a case. I didn’t eat anything that week. Imagine if your face started turning into endless, massive pimples. I mean zits so numerous and so big that they obliterated your facial features and swelled up full of p- okay, I’ll stop.

This should tie you over.

A normal kidney is about 4-5 inches long and weighs about a quarter pound. A kidney with advanced PKD can be multiple feet long – yeah, really, feet – and weigh more than ten pounds. Also you pee blood sometimes. No big.

Yeah, that disease needs a new kidney for sure.

Of course, there are a few people left in the world that somehow survive to Medicare age on their normal two kidneys. According to my professors this happens approximately 0.01% of the time and you should absolutely freak out about it now.

Finally, some unsolicited kidney-related medical advice:

• Drink water;
• No, not that much;
• Definitely don’t take ecstasy and drink fifteen bottles of water at a rave;
• If you get trapped under a building during an earthquake, I hope you have a donor match;
• If you have the opportunity to donate a kidney, do it. This is especially true if your recipient is a significant other or contentious family member, because you have automatically won every fight and argument now and forever.
  • Also love and humankindness and sharing the spare yadda yadda.

You’re welcome. I’ll be here four more years.