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CKD patient. Getting fluctuate creatinine level. What should be done?

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My father is a CKD patient from 2009. His creatinine level was fluctuating between 3 and 4 till December 2012. On 24th december he was admitted to a nearby hospital with complaints of nausea. Then his creatinine level was found to be 13. From 24 till 7th January 2013 after 5 dialysis the creatinine level has come down to 7. His urea level was 167, now it is 97. His hemoglobin level was 8.5 on 24th but now it is 7.9. He has been having mild fever from 20th December 2012. His ESR level was 82 (normal lvl 1-10) on 27th December 2012. WBC count was 0000 cells/cmm and Platelets count was 3.11 lakhs/cmm. He had measles induced nephritis when was 6 years old. Today he was having a fever of 101 f. I would like to know if this spike in the creatinine level is due to some infection.
Posted Tue, 29 Jan 2013 in Kidney Conditions
Answered by Dr. Ravi Bansal 11 hours later

Your father is suffering from advanced renal failure and dialysis is indicated. Now there are two things to understand.

1. Why did the creatinine rise suddenly?
When the creatinine is around 4.0, the kidney works only around 15% of its normal capacity. Any small insult in the form of - infection (chest or urine), use of pain killer medicines, high blood pressure or high blood sugar, diarrhoea or vomiting, unknown desi medicines - can result in sudden jump of creatinine level.
To diagnose all these we need complete patient history and run battery of tests - especially urine routine, urine culture, blood culture, and ultrasound abdomen, chest x-ray.

All these are missing from the reports supplied. The Total leucocyte count is borderline high 0000 and patient has fever - this shows patient definitely has an infection now. ESR has not much relevance; it can be high even with anemia.

We might be able to predict the cause of this spike in creatinine level if all the aforementioned data is available.

2. Whether the kidney will improve or not?
This is hard to predict. 70 to 80% patient’s serum creatinine will fall back to pre-illness level, while other will remain on dialysis. His treating nephrologist would know about it - may be not now but few days during his treatment.

Hope I have addressed your concern. Feel free to ask any other question
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