What could be causing indigestion and fever while undergoing dialysis sessions?

Hello,

Welcome to icliniq.com.

I understand your concern.

I see you are on dialysis sessions, having indigestion and a feverish feeling. So I need to ask a few things before I advise you something.

1. How much urine you are passing?
2. Is dialysis accessed by a fistula or catheter?
3. What is your PTH (parathyroid hormone) and vitamin D level?
4. What is your vaccination status?
5. What is your ferritin level?
6. Have you checked viral markers such as hepatitis B, C, and HIV (human immunodeficiency virus)?
7. What is your appetite status?

I hope this information will help you.

Thanks.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have reviewed the attachments (attachment removed to protect the patient's identity), and your potassium and creatinine levels are rising. Please stop tablet Lisinopril immediately because that is causing your creatinine and potassium to rise. I suggest you some tests and medications that you should take. You should book a visit to your dialysis center because even though you have adequate urine output, your potassium is high, which is unsuitable for you.

1. Tablet Sodium bicarbonate 500 mg thrice daily.
2. K bind powder (calcium polystyrene sulphonate) sachet twice daily with syrup Lactulose for three days.
3. Continue with the tablet Torsemide 50 mg.
4. Tablet Alpha Ketoanalogue 200 mg thrice daily. However, please consult a physician, discuss with them, and start taking the medications with their consent.
5. Have a vegetarian diet. But avoid high potassium diets like bananas, tomatoes, potatoes, nuts, oranges, and dairy.

Undertake the following investigative tests mentioned below.

1. IPTH (intact parathyroid hormone) levels.
2. Serum calcium, phosphorus, and vitamin D levels.
3. Urine routine test.

Repeat the potassium level after three days and follow up with the investigations I advised.

I hope this information will help you.

Thanks.

Hi,

Welcome back to icliniq.com.

I understand your concern.

It is good that your potassium has decreased now. Do not start Lisinopril for now. Your hemoglobin should be between 10 g/dL to 11 g/dL, so I want you to begin injecting Darbepoetin 40 mcg subcutaneously once weekly. For throat itch, you can do salt water or betadine gargles with warm water thrice a day. If it does not help, take tablet Levocetirizine 10 mg at night for three days. Vitamin D3 60K once-a-week sachet you can take for six weeks. Rest and continue all the previous medication as I advised with a low potassium diet.

I hope this information will help you.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern.

I have gone through your reports. Your creatinine is relatively high. What about your general condition? How is your appetite, urine output, blood pressure, and swelling? Are you on dialysis again?

I hope this information will help you.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern.

You may have sent me the wrong attachment. Anyway, to confirm if it was due to post-streptococcal glomerulonephritis, a kidney biopsy has to be done, which can be performed if the kidney size is normal. Secondly, if stage 5 kidney disease has already occurred, then the chances of recovery are slim, even if we find out the underlying cause. Swelling in the face may occur in kidney disease due to protein leakage in urine. Kindly send me your recent reports and urine protein-creatinine ratio.

I hope this information will help you.

Thanks.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Has any recent ultrasound of the kidneys been done yet?

I hope this information will help you.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, it would help if you went for an ultrasound and urine test with a urinary albumin-to-creatinine ratio (UACR). To check for mineral bone disease, you should also get intact parathyroid hormone (PTH), calcium, phosphorus, and vitamin D levels. If your hemoglobin is above 10, then tests related to iron are not required.

I hope this information will help you.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern.

I have reviewed the attached reports (attachment removed to protect the patient’s identity). I can see leukocytes in your urine. Are you experiencing burning during urination? For other matters, please continue with the medication I advised previously. Maintain water intake equal to your urine output in 24 hours, plus an additional 17 ounces. Avoid a non-vegetarian diet, alcohol, and smoking. Maintain a low-salt diet, consuming less than 5 grams per day. Consume fruits and vegetables daily, but avoid bananas, mango, oranges, coconut water, dates, juice, and leafy vegetables. You may consume all other green vegetables and fruits. Your protein intake should be less than 0.8 grams per kg per day. Take Alpha-ketoanalogue 200 mg thrice daily. Also, take tablet Nodosis (Sodium bicarbonate) 1 gm twice daily.

I hope this information will help you.

Thank you.