[doctor] okay . next patient is ashley james , date of birth 12/27/2006 . ashley is a 14-year-old female , uh , who was previously healthy , now here for evaluation of abnormal renal ultrasound with an atrophic right kidney . hi . good afternoon , ashley . how are you doing ?
[patient] i'm doing okay . how are you .
[doctor] i'm doing well . thanks so much for asking . i'm dr. rogers . i'm one of your kidney doctors . and you guys must be mom and dad .
[patient] yes , that's correct .
[doctor] great . well ... all right . it's so nice to meet all of you . i wish it was under better circumstances , but we're gon na figure it all out , uh , here today . um , speaking of that , let's go ahead and review some of your past medical history , and then i'll complete an exam of her heart and lungs and kind of move from there . would that be all right with you , ashley ?
[patient] yeah , that sounds good .
[doctor] okay . so as i understand it , ashley was found to have a small ... kind of a small kidney on one side . tell me about when that was . um , i do also have records of everything , but i'd just like to hear the story of how it was found out and what you're doing that got us here , uh , today .
[patient_guest] sure . so ashley came home one day sick out of nowhere , rubbing her stomach , and she said it was hurting on her right side . and it was so bad that she was bent over in pain .
[doctor] okay .
[patient] we automatically thought appendix .
[doctor] sure . that makes a lot of sense .
[patient_guest] we took her to her doctor . they treated her for a stomach virus . they get her fluids and sent her back home , and the next day she was twice as bad as the first day .
[doctor] goodness . okay . then what happened ?
[patient_guest] yeah . so i took her back again and they did more testing . i think they did an ultrasound or something , and that's where they found that one kidney was bigger .
[doctor] okay .
[patient_guest] um , then at that time they told us to followup with our primary the next day , which we did . um , but he was heading out on vacation , so he only saw her for a brief 10 minutes and then we were out the door . so she was still throwing up , in a lot of pain , so i took work off to help her .
[doctor] wow . okay .
[patient_guest] uh , we took her down to jacksonville , where they did see her and basically told us the same thing , that they did n't think one of her kidneys was working at all . they called it atrophic and that it was a lot smaller than the other one .
[doctor] all right-y . then- then what happened ?
[patient_guest] yeah . then , um , they found cysts or something on her kidney and ovaries and maybe some other places . her lymph nodes were swollen and they found some infection . um , they told us to followup with her doctor , which we figured since she was still sick .
[doctor] okay . and then when you followed up with your doctor , what happened then ?
[patient_guest] yeah . it did n't seem to be getting any better within a day or two , so we followed back up with her doctor , who was , of course , still out of town with no one to see her in his place . so we ended up coming to atlanta . we stayed here for about four days . um , they did see her and treated her .
[doctor] okay . i am so sorry for all of that back and forth , but glad to know that there was some light at the end of that tunnel .
[patient_guest] thank you . and then after they saw her , she did seem to get a little better . she has n't had any more throwing up or anything since , but she still complains about a lot of pain in her stomach .
[doctor] mhm . okay .
[patient_guest] yeah . and she mentions burning too , especially when she eats and stuff like that .
[doctor] all right-y . okay . well , that was a really good review . so , ashley , before all of this , would you say that , all in all , you were a pretty healthy child ?
[patient_guest] she is , yeah . before that , she was completely fine . uh , they said they think at some point she had a severe infection that might've affected her kidney .
[doctor] got you . okay .
[patient_guest] so one other thing , too , um , when she was four years old she was in the hospital three or four times , sometimes for three days at a time . i do n't think they did any tests to see what the infection was or even where it was coming from . um , they just gave her fluids and antibiotic and they would send us home .
[doctor] hmm . okay .
[patient_guest] yeah . and so a week or two later , she would have a fever and symptoms and basically the same thing . we went through that for a couple of months , and then it just stopped . so she had no problem since , but the doctor suspects that she's had kidney problems since then . so we just wan na see if she's all right or if she ... if it needs to be taken out maybe . we wan na do whatever needs to be done .
[doctor] yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ?
[patient_guest] only pepcid .
[doctor] okay .
[patient_guest] yeah . so she takes 40 milligrams of pepcid a day and then also takes claritin for allergies .
[doctor] all right-y . and any difficulties with your pregnancy with her or during delivery ?
[patient_guest] no . um , renal disease does run in my family , though . my dad , aunt , and my cousins all have issues with their kidneys . i have their paperwork right here for you with their diagnoses .
[doctor] great . i will definitely review that over . any other , uh , family history to be aware of ?
[patient_guest] yes . my mom had breast cancer too .
[doctor] okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ?
[patient_guest] yes , that is correct . he did .
[doctor] okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ?
[patient_guest] yes , and they did n't catch it in time .
[doctor] i'm so sorry to hear that .
[patient_guest] yeah . he actually died at 47 of a massive heart attack .
[doctor] my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care .
[patient_guest] you're welcome .
[doctor] okay . so you said her aunt also has had kidney disease ?
[patient_guest] yes . well , it was my dad's sister , so her great aunt .
[doctor] okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned .
[patient_guest] um , this is what she sent me , " end-stage renal disease . chronic kidney disease stage five , diabetes , hypertension . " that's all i have , uh , to work on for her .
[doctor] okay . uh , and that's ... okay . let me see . that is all when ... she was an adult when all of that happened ?
[patient_guest] correct . yep .
[doctor] all right-y . okay . and it also looks like ashley has seen a gi and a geneticist , where they did n't find anything sig ... clinically significant mutations on the panel that they did .
[patient_guest] yes .
[doctor] okay . so that's all good . so , ashley , um , a few questions for you if that's all right . how are you feeling right now ?
[patient] i'm not feeling too bad . my stomach just hurts just a little bit . it's burning a little bit .
[doctor] okay . and any pain when you go pee ?
[patient] sometimes it's just hard to start , sometimes .
[doctor] okay . and any blood in your pee ?
[patient] no , not that i've noticed .
[doctor] okay .
[patient_guest] she does complain that it burns when she pees when she drinks certain drinks , um , like , soda . so she'll only drink gatorade or water .
[doctor] okay . yeah . so we do see that some people are very sensitive when the drink certain items , especially the carbonation . um , it can make it burn a little bit when they urinate . um ... okay . so a lot of different pictures of her kidneys here , and we'll review all of that here in a moment . um-
[patient_guest] okay .
[doctor] all right-y . but before we review that , i wan na look through a quick exam , uh , and just see how things are doing . you'll hear me speak aloud the exam just to make sure i'm getting everything documented .
[patient_guest] okay .
[doctor] all right-y . please use my physical exam template . so , ashley , i'm gon na listen to your lungs and heart , if you'll just breathe normally for me . okay ?
[patient] okay .
[doctor] good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee .
[patient_guest] okay .
[doctor] or , excuse me , her pee . uh , her right kidney is a little bit smaller which is making her left kidney work harder , possibly causing the left to appear bigger , um , and it's something that we wan na keep an eye on but nothing for us to do with anything today .
[patient_guest] okay . thank you .
[doctor] i also recommend that , on an annual basis , we do kind of the following things . so i wan na have an ultrasound to monitor the size of her kidneys and their overall function , complete a urinalysis to continue to make sure that protein and blood are not in her ... in her pee , and do a blood pressure check . additionally , let's avoid non-steroidal anti-inflammatory medicines like ibuprofen and opt to use tylenol instead .
[patient_guest] okay . that sounds good .
[doctor] okay . and does ashley play any sports ?
[patient_guest] yes . she is active in softball and she wants to join the drill team over the summer .
[doctor] how fun . i used to play softball back in the day . um , so it'll be very important that during those activities she stays well-hydrated . i really wan na avoid dehydration , as it puts tremendous strain on her kidneys . so i'm gon na recommend at least two liters per day of water .
[patient_guest] okay . great . we will work on that .
[doctor] okay . i also recommended a healthy diet and continue her active lifestyle . this will help keep her and her kidneys healthier as an adult . so if we can start those behaviors early , we'll be in a good space as she progresses .
[patient_guest] we can do that . we already do try to eat , uh , very well .
[doctor] good . good . so for her next appointment , she can either meet with her primary care physician or an adult nephrologist closer to you guys at home . you do n't have come all the way out here .
[patient_guest] okay . that sounds great .
[doctor] okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse .
[patient_guest] no . i do n't have any additional questions , and i'll- i'll definitely give you a- a phone call if we do . and thank you so much . this was so helpful .
[doctor] awesome . well , thank you guys for making the trip . and , ashley , it was really nice to meet you . mom dad , you as well . and i hope you guys take care .
[patient_guest] you too .
[doctor] all right-y . past medical history , review of patient's grandfather's record , we see he had posterior urethral bowels valves and obstructive neur- neuropathy . uh , he developed chronic kidney disease and was on dial ... was dialysis-dependent . he had a renal transplant which subsequently failed , died of dialysis in his 40s . , wait . is that right ?
[patient_guest] now that you've started , it does ... i do n't understand the he unless they were giving ... , the grandfather's record . but did you wan na do this on your own this recording ?
[doctor] yeah . that's ... yeah . that'll work 'cause i'm gon na have to drop for this . but i think we're good for everything else .
[patient] and he did die in his 40s . that's what it said in the note earlier .
[doctor] okay . yeah . he died in his 40s , but i thought it was from a massive heart attack . died at 47 of a massive heart-
[patient] he died ... it- it's saying that it meant ... it means he died on dia ... like , he was ... he was , um , utilizing dialysis .
[doctor] not because of it . okay .
[patient] yeah .
[doctor] i see what you're saying .
[patient] yeah .
[doctor] got it . cool . i'm gon na stop-

Medical orders:
description: annual basis ultrasound
order_type: imaging
reason: atrophic right kidney to monitor the size of her kidneys and their overall function
description: pee annual basis urinalysis
order_type: lab
reason: atrophic right kidney to continue to make sure that protein and blood are not in her ... in her pee