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Creatnine levels is high and potassium level low. Is it safe to go for dialysis?

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My father-in-law's Creatnine levels have been alarmingly high for the last few days. Currently he's in a hospital under observation. He refuses to be put on dialysis. His potassium levels were down, therefore the doctors are giving him potassium. He's passing urine normally and his other body functions are also fine. The doctors say that his hemoglobin levels are good that is why his body is still functioning well. And again the doctors say that dialysis cannot be immediately given as it may impact his heart since he had an Angio. His Angio happened 5 years ago and not recently.

A week ago, his BP suddenly shot up to 180. When he went to a doctor, he was suggested to go for a kidney test and the results showed alarmingly high creatinine levels of 7.8. The next day he got his blood test again from a different lab and the creatinine levels shot up to 9.8. Thats when we got him admitted to a hospital. The hospital suggested that he should immediately go for a Dialysis. But he is adamant of not going through that as according to him, he's passing urine normally and his appetite is also fine. The doctors at the hospital are saying since his hemoglobin is good, his body functions are working fine. Basically we are confused - His condition seems to be normal, but his reports are showing altogether different picture. His potassium levels were high and not low. Therefore he was being given medication to reduce those levels. The doctors mentioned that high potassium levels could impact his heart.

However, all other functions are normal. The doctor himself said that my Father-in-law passed almost 3L of urine yesterday. We believe that in itself is a sign that kidney is doing fine. The creatinine levels have come down by 2 points within 2 days. Today his creatinine levels have reduced to 7.1. All other vital symptoms that you mentioned (like nausea, anorexia vomiting, breathlessness or drowsiness) are also not present. What would you suggest?

My questions are - Are they correct in saying that hemoglobin levels are making him survive this condition?

Second Question - If he goes through dialysis right now, would his heart be able to sustain the pressure, considering he has stents in his heart?

My father in law has been discharged from the hospital after an ultrasound. I have attached the ultrasound report (Photo 2, Photo 3 and Photo 4) along with this webpage. The report mentioned that his kidneys are of perfect shape but they have some swelling over them. The doctor said, due to this swelling, the creatinine levels have been high. And he gave this reason to discharge him from the hospital.

Third question - Can you please let us know if we should consult another doctor since his creatinine levels are still high (7.7)

Can you please suggest how we should proceed?
Posted Thu, 15 Nov 2012 in Kidney Conditions
Answered by Dr. Ravi Bansal 1 hour later

I have gone through the reports also.

I must tell you there is nothing to be confused.
Your father in law is suffering from renal failure, and there is no doubt what so ever. But the next question is whether this is permanent damage or the kidney can recover. Generally if the creatinine value has shot up rapidly because of some reason-- infection, medicines, high blood pressure-- then it may come down if you control the primary event.

In your case since the kidney size and echotexture on ultrasound suggests some damage then the kidney may not recover completely.

Now the issue is whether to do dialysis or not.-- kidney failure is not like a yes/no phenomenon, it is a spectrum varied from mild failure to severe failure. And depending on the severity if the kidney function has gone down so much that it will risk his life then dialysis has to be done. Remember urine flow is not the only function of kidney. Even if patient has three litre urine but his creatinine is rising or the potassium or acid level is rising or patient has encephalopathy or pericarditis, dialysis may still be required.

Then how u will come to know if it is required? I think you will have to listen to your treating nephrologist here, if he says it is required then you have to trust him. He only can determine after detailed examination of the patient and reports.

Is your patient diabetic that is not mentioned in the history?

Your question- haemoglobin is making him survive-- I think that is a miscommunication or misinterpretation on your part. Good Haemoglobin definitely means that the kidney disease may be acute and may recover also good haemoglobin is required in any serious patient to tide over the crisis. But if it is low you can transfuse blood to raise its level.

Other question- patients of heart disease with stents can easily undergo haemodialysis. Only thing is if the patient does not have good blood pressure or is having active angina- he can develop heart problem during dialysis otherwise it can be safely done.

You should consider the fact that if dialysis is required as per your doctor and is not done then it is an imminent risk to the life of the patient.

Your case should be under treatment of a nephrologist.

Hope this helps! Do write back if you have doubts.


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