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Suffering from kidney disease and one sided paralysis. Feeling nausea after dialysis. Prognosis?

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Nephrologist
Practicing since : 1994
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Hi,

This is to ask you a query regarding my father, aged 62.
For his medical history, he has been suffering from kidney disease and left sided paralysis.
On january 2, he complained of breathlessness and had his angioplasty done and was discharged.
Two days later, he felt short of breath again and doctors confirmed that he had water in his lungs for which the doctors started his dialysis.Within 7 days, he has had 4 dialysis done so far and was discharged yesterday.
Currently, his hemoglobin level is 7 and he has been feeling very weak and has lost appetite and feels nauseated at the sight of food.

Could you please tell me what his symptoms suggest and what could be done in this case ?
Also, what are the food items that he can take in order to increase the hemoglobin levels without affecting his health.
Posted Sat, 23 Feb 2013 in Kidney Conditions
 
 
Answered by Dr. Sree Bhushan Raju 1 hour later
Hi, there are certain clinical issues not clear in your data. Please let me know about the following, so that I give a specific response.

1. Is your father already on HD before CAG and PTCA?
2. What was his creatinine prior to CAG /PTCA (angioplasty)?
3. What about other parameters before or at the time of PTCA
4. What was the time gap between CAG and PTCA?
5. Did he take precautions before CAG?

As per the history given by you, it suggests that he has" acute" (temporary) shut down in the kidney function. He is likely to improve (towards non-dialysis dependent stage, if not to absolutely a normal) in the due course. He would require few more weeks of observation before calling it “Failure".

Please get his creatinine done before the first dialysis of the week and observe the rate of fall of creatinine and his urine output over this period.

Awaiting your response.
Above answer was peer-reviewed by
 
Follow-up: Suffering from kidney disease and one sided paralysis. Feeling nausea after dialysis. Prognosis? 30 hours later
Hi doctor,

Sorry for the late reply, I was trying to get the necessary information before answering.
Please find my answers inline :
1. Is your father already on HD before CAG and PTCA? No(but he had the kidney disease for four years prior to this)
2. What was his creatinine prior to CAG /PTCA (angioplasty)?
3. What about other parameters before or at the time of PTCA
My father was admitted to hospital on XXXXXXX 3rd, mentioned below are the KFT reports on the following dates :
4th Jan: 165(urea), 4.6 , 140, 4.8
5th XXXXXXX : Angiography done
5th XXXXXXX (Post angiography) : 162(urea), 5.1, 141(sodium), 6.0 (potassium)
7th XXXXXXX : Angioplasty done
7th Jan(Post angioplasty) : 200(urea), 4.9 , 139, 4.5,8.3(calcium), 1.8(magnesium)
4. What was the time gap between CAG and PTCA? About 48hrs(appx)
5. Did he take precautions before CAG? Yes, he has been on renal diet(low protein diet for last four years)


After his angioplasty he got discharged on XXXXXXX 10th but when he complained of breathlessness again, he was admitted on XXXXXXX 18th and doctors did the X-ray and confirmed he had water in his lungs due to which they suggested dialysis to be done.

He had his first dialysis on XXXXXXX 23rd (and then on 26th,28th,30th) and following were the KFT reports :

18th : 139(urea), 5.1(Cr), 142, 5.5(potassium)
21 : 159(urea), 5.74(Cr) , 139.40, 5.37(potassium), uric acid(7.77), 8.9 (haemoglobin)
Post dialysis
29 : 57.10, 3.88(Cr), 141(sodium), 3.89(potassium), 7(Hb)

Please let me know if this information is good enough for you to assess his kidney stage and also to suggest what should be our next steps.
The doctors have suggested him to undergo dialysis twice a week, please let me know if there is any alternative action that we should be taking.

Thanks much in advance, XXXXXXX
 
 
Answered by Dr. Sree Bhushan Raju 2 days later
Hi XXXXXXX
Thanks for writing back.
As per your information, the kidney function was not good prior to CAG and PTCA. Surprisingly , you were not aware of that I feel he was not under followup with any doctor. It looks like the kidney function did not deteriorate much after CAG and PTCA. However the PTCA procedure was an important one as heart function should be preserved by all possible means. It was a necessary procedure with a slight risk of deterioration in kidney function which really did not happen in a big way. He requires dialysis only for few days as kidney function also will improve once the heart function improves which we see very frequently in our practice. Monitor his renal functions like creatinine etc before the first dialysis of the week. Watch his urine output. Give him a adequate diet and water around 1-1.5 lit per day. Continue with all the drugs given by his cardiologist and verify with your doctor if there is any drug in his prescription which will affect his kidney function
Hope that helps. Let me know if you have any more questions
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