Meet Dr Stephanie Chong, one of the medical specialists who contributes to the knowledge within Dem Dx.
Why did you choose medicine as a career?
I came to the UK at the age of 13 because I wanted to ride horses and whilst a bad accident made me put my dream on hold, it gave me a first hand look into the medical profession. It was a natural fit because I loved to interact with people and had a naturally inquisitive nature that loved problem solving and science. changes to therapies to extend and improve quality of life in the face of kidney failure.
How did you come about selecting your speciality?
I chose renal when I was a medical student after doing a special study module. I found the module lead incredibly inspirational as he was able to combine a strong academic career with a reputable clinical practice. I was attracted by both the application of pathophysiology to everyday clinical practice and the strong relationships built from supporting patients through the onset of disease to end stage kidney disease, commencement of renal replacement therapy and potential transplantation. It is a diverse field with exciting research possibilities in an era of revolutionary.
What is a memorable moment in your career?
As a foundation doctor doing a cardiology firm, I would often manage patients with heart failure on diuretic therapy. I had a patient with significant chronic kidney disease stage 3 (with an eGFR 30-40) who was admitted with symptomatic fluid overload and hypotension. Over the next few days, his serum creatinine serially increased, which was presumptively attributed to the diuretic therapy, resulting in a reduction and cessation in diuretic treatments despite on-going fluid overload (as determined by on-going peripheral oedema, oxygen requirement and the lack of daily weight reduction).
The following day, he developed frank pulmonary oedema, hypotension, and deteriorated acutely, requiring urgent diuretics, non-invasive ventilation, and ionotropic support. This patient was in cardiogenic shock and withdrawal of his diuretics had likely led to increased fluid retention and increased cardiac workload causing the decompensation. His low cardiac output had resulted in low blood pressure which impeded the efficacy of the diuretics. Increasing his blood pressure with ionotropic agents led to increased renal perfusion which led to increased diuretic delivery to the nephron, allowing for increased salt and water excretion.
This reminded me of the importance of applying physiology and considering the whole clinical picture rather than simply reacting to blood tests. Similarly, this patient could have had a rapidly progressive glomerulonephritis presenting with fluid overload and renal impairment, which would have been missed if a urine dipstick test had not been done and renal impairment was presumed to be diuretic related, this would likely then had led to delayed treatment and minimal chance of renal recovery.