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Dr. Andrew Rynne

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70 years old with high creatinine level. Normal kidney. Undergone dialysis. reason for the high level?

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Dr. Sree Bhushan Raju

Nephrologist

Practicing since :1994

Answered : 92 Questions

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Posted on Wed, 30 Jan 2013 in Kidney Conditions
Question: Dear Sir,
My mother is 70 Years old. She was admitted in hospital on 21st-dec'12 due to her face swelling along with legs. Test being carried out and found that water in chest by chest xray and the createnine was 3.4. The water being removed from lung by tapping. After that swelling of face and legs been diminished but createnine value increased to 5. The doctor then carried out the dialysis of kidney. But still the satisfactory result not been shown. After that She had been refered to another doctor, where it had been detected that she is suffering from pneumonia and accordingly TAVANIC & LUPINEM medicine for 7 days given. In the meanwhile another 3 times dialysis being carried out. But, still the urine quantity was minimum (approx. 70 ml /day). On 6th-Jan'13 evening waxy fluid type urinie is excreated in small quantity. Then again creatinine being tested on 7th-Jan'13 & found that the level was 9.5 and seruum urea was 128. Then doctor prescribed another medicine on 7th-Jan'13 i,e. ZOXTIL-CV 500 mg (1/2 tab twice in a day). Hb was 8.5. On 7th-Jan'13 night, she faced respirataory problem for which oxgen being given and on 8th-Jan'13 again Dialysis being carried out. My questions are as follows:
1. In the month of Sep'12, createnine was normal (1.1) and she is not diabetic, so what may be the cause of her kidney not functioning properly now?
2. As per sonography both Kidneys are normal in size done on 27th-Dec'12. Why urnie output is not coming to normal?
3. what may be the reason of her createnine not coming to normal value ?
4. Please advise how can my mom will recover soon?
doctor
Answered by Dr. Sree Bhushan Raju 2 hours later
Hi,

Thanks for sharing your concern with us.

Your mother has what is known as XXXXXXX Acute Kidney Injury"(AKI). It means that her kidneys are injured XXXXXXX temporarily" maybe due to an infection ( may be creatinine starts increasing and they end up in complete shutdown of all functioning units of the kidney called nephrons. In fact, the creatinine will not increase from normal ( less than 1.3 mg/dl) to abnormal ( more than 1.5 mg/dl) unless the kidney function deteriorates by more than 50 %. So she must have had an injury to kidney even before admission into the hospital itself. As the kidney function deteriorated the doctors took the decision of supporting the body in form of dialysis which substitutes the function of the kidney. Dialysis is an effective modality of replacing the work of kidneys and has got no major complications and even if they occur, they can be tackled effectively as most of the major centres in the country are well equipped.

Kidneys can look normal in USG as she has AKI. As the kidneys are in a state of XXXXXXX shock" , it takes some time for the kidneys to respond and come out of crisis and pour out urine. It might take few weeks ( some times months) to totally come out of such a crisis. The doctors will recheck the creatinine frequently , preferably after withholding dialysis for a day or two, in between and monitor the renal functions whether they can stop HD for or not. As the kidney opens up, the patient starts excreting urine and gradually improves her urine output and settles down. As the kidney functions improves the creatinine also would decrease and come to a lesser number. As your mother is an elderly lady, chances are high that she would take few more days . She is on "higher" antibiotics for infections. So you need to wait and see . The doctors will take all appropriate precautions o take care of any complications that arise during the hospitalizations

Hope that helps

Let me know if you have more questions

Regards
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Sree Bhushan Raju 24 hours later
Dear Sir,

I acknowledge the receipt of your kind reply and noted the contents there of.

The concern is that there is breathing problem for the last two days and she is in the support of oxygen inspite of chest clear. The urine output is still negligible and that also with waxy fluid. Burning sensation also felt in urinary point from the last 2-3 days.

The Doctor Mr. M.R. Mazumder the renowned nephrologist Mediland Nursing Home of Silchar, District Town of the state of Assam advises for Kidney biopsy which cannot be possible at present for obesity , breathing difficulty, old age.
Haematology report conducted on 2nd January’13 shows:
Total Leucocytic count: 0000
Neutrophil 77%
Lymphocyte 21%
Monocyte: 01%
Eosinophil 01%

URINE EXAMINATION REPORT: Conducted on 7th January’13

Physical Examination:
Colour : Straw, Deposit: NIL, Specific Gravity: QNS, Reaction : Acidic
CHEMICAL EXAMINATION:
Sugar : NIL, Albumin: +++
Microscope Examination:
Pus Cell: Plenty, Erythrocyte: Nil, Epithelilal Cell: 2-3/ HPF, Granular Cast Nil , Crystals Nil, Calcium Oxalate are NIL.
Urine RE culture report awaited:

What is the inference from the above test.

Today, injection given is MAGNEX FORTE 1.5g OD as she cannot tolerate oral medicine.
My mother also has a secondaries in liver for which therapy was done in AIG , Hyderabad in the last year.

Sir, please advice how long to wait for the resumption of kidney function and other than this no other major problem. Now , my mother is weak with the intake of strong antibiotic

Is there any medicine which can buid up her vitamin defeciency and feel better . Though she is taking Becosule - Z one tab daily.


With regards and agogly awaiting for your reply please.

XXXXXXX
doctor
Answered by Dr. Sree Bhushan Raju 20 hours later
As we discussed earlier, she has AKI due to UTI. The reports submitted are also suggestive of the same.

She is on antibiotic and I feel that it must have been started based on the urine culture sensitivity pattern only.

As the kidney is unable to filter properly, the excess water is getting accumulated in water and lungs can be still clear and that excess water can be removed successfully by Hemodialysis. Otherwise, an underlying cardiac condition can be evaluated looking at her age.

Can you please elaborate a little bit more on the secondaries in liver and treatment given a year back, as it definitely influences the outcome in this case?

Regards,
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sree Bhushan Raju 16 hours later
Dear Sir,

Thanks for your kind reply.
But Sir, I am much worried about my mother as after prolong hospitalization and medication also She is not recovering. As per your comment, kidney is affected due to UTI and there are variety of antibiotics drugs and choice of the drug depends on the complication of the infection. For the last two days, Magnex Forte 1.5g is injected on OD basis.
But the urine output is still minimum with waxy fliud and yesterday urine output is not even 30ml.
Whether the medicine is OK or another antibiotic is required and what will be the duration of course.
URINE CULTURE REPORT : on 10.1.13

Culture shows growth of Klebeielaa App after 24hrs of aerobic incubation.

Colony count 1X10⁵ CFU /ml of urine

DRUG Sensitivity

Sulbactum Sensitive
Piperacillin Sensitive
Amoxyclav Moderately Sensitive
Cotrimoxazole Resistant
Cefadroxil Resistant
Cefuroxime, cefotaxim,ceftiaxone Resistant
Cefoperazone Resistant
Ciprofloxacin MODERATELY SENSITIVE
OFLOXACIN MODERATELY SENSITIVE
GENTAMICIN SENSITIVE
AMIKACIN SENSITIVE
LEVOFLOXACIN SENSITIVE
IMIPENUM SENSITIVE
MEROPENUM SENSITIVE

Sir, Can you please suggest with any other antibiotic or the Magnex Forte 1.5 g will do.
Any medicine that can energise her body.
For the last two days the sugar level also crosses 210 XXXXXXX and even 300. After injecting insulun it comes down to less than 150.
Catheter is under use since 22nd December and only the bag is changed . Whether the long use of catheter is require replacement of catheter.
Yesterday night , it was severe breathing problem and after injecting deriphylin and Cort -S , it was became normal.
Today, again HD will be done.
Please put forward your valuable suggestion so that my mother recover soon.

With best regards:

XXXXXXX
doctor
Answered by Dr. Sree Bhushan Raju 19 minutes later
As per the culture sensitivity report, the antibiotic can be changed to Piperacillin or an alternate sensitive antibiotic of your doctor’s choice. We can still see an improvement in her condition after changing the antibiotic.

It all depends on her general condition prior to the onset of this particular ill health.

Let her get few more sessions of Hemodialysis and see.
Improve her nutrition by giving her high protein diet.
Foley’s catheter for a prolonged period can definitely increase chances of sepsis. It should be changed at least once a week so that her Urinary Tract Infection will not be prolonged.
Make sure that her blood sugars are checked once in 8 hrs to keep sugars at around 130- 150 mg /dl.

Let me know if you need further assistance.
Please close this discussion if all your queries are answered.

Regards

Above answer was peer-reviewed by : Dr. Prasad
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