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Diabetes IDDM, have elevated S.urea and S.creatinine level post edema treatment, diagnosed with UTI, advised AV fistula fitting. Am I heading towards dialysis?

Hi I am Sujata 69 Female from India.I am DM type 2 IDDM since last 25 years. Taking Humalog TDS and Lantus in night at 11 pm.My S. urea and S. Creatine level had started to rise and with all possible control on Blood Pressure and Sugar my S.urea 88 mg/dl S. Creatinine 4.6 mg/dl on 21.6.2012 when I was hospitalised for EDEMA due to Anemia Hb 8.6%.After discharge swelling on my ankles and feet was gone,was put on Erythropotien injection 0000 iu every ten days.My Hb improved to 9.8%.But S.Urea increased to 112 mg/dl and S.creatinine 6 mg/dl. Was diagnosed with UTI.Prescribed Nitrofuraton Bd for 7 days and Amikasin inj250 mg OD for 7 days.These were found SENSITIVE in Urine culture report.I have been advised by NEPHRO to get AV fistula fitted.What to do now.Am I inching towards Dyalisis?
Asked On : Tue, 17 Jul 2012
Answers:  3 Views:  97
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Internal Medicine Specialist 's  Response
Dear friend,

welcome to HCM !

I am concerned with your uraemic trends. I think you have diabetes related chronic kidney disease which has worsened with UTI.

rising urea, creat, oedema and overall trends suggest worsened renal function and as per your nephro advice, you may need dialysis soon.

AV fistula is planned for dialysis.

pl. go by your nephro. advice.

hope you recover soon . and do not fall prey to gossips/ unauthentic advises.

pl. keep me posted on your progress.

Answered: Tue, 17 Jul 2012
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General & Family Physician Dr. Pavan Kumar Gupta's  Response
Since your kidney functions are deteriorating,dialysis becomes a must and AV fistula is being created for dialysis only.
An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It is being surgically created for hemodialysis treatments.

Patients with end stage renal failure are treated with hemodialysis. In dialysis, blood is withdrawn from an artery or vein, purified, and returned to a vein. The volume of blood is too great for veins to handle, so a vein must be enlarged. An artery and vein, usually in the arm above or below the elbow, are sewn together, to create a fistula, and arterial pressure eventually enlarges the vein. The enlarged vein can accommodate a cannula or large needle.
Answered: Tue, 17 Jul 2012
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Nephrologist Dr. Bakshish Singh's  Response
Unfortunately there is no permanent cure of chronic kidney disease at present. I am more worried about the present UTI as nitrofurantoin should not be used in advanced CKD and Amikacin is also toxic to kidneys. If absolutely necessary the dosage of Amikacin should be reduced Further. Planning for an AVF is advisable to have an uneventful dialysis whenever is the need. Hope you recover from the UTI.
Answered: Tue, 17 Jul 2012
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