Dr. Anshul Varshney
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
A healthy 60-year old woman walks seven miles a day and has no underlying illness (autoimmune, cardiovascular, cancer, etc) very suddenly develops renal failure over about one month that doctors at the general hospital diagnose as microthrombotic angiopathy and hemolytic uremic syndrome. Creatinine of 7, Hb 7.1. She does not seem to respond to plasmapheresis or dialysis well. Has 4+ pitting edema in hands, arms, legs, feet. BP 190/84. She has had three sessions of hemodialysis over five days. She is very nauseated. The patient believes that she began to be sick after she changed from brand name Osteocalcin (salmon) spray to a generic form. Do you think she could be having an idiosyncratic reaction to the fish calcitonin which has been stopped?
Hi,
Welcome to icliniq.com.
No, changing the brand is not a reason to develop microangiopathy and HUS (hemolytic-uremic syndrome). She needs to be convinced to accept what has happened.
She would require hemodialysis sessions thricea week with adequate diuretics.
The pedal edema is mostly because of low protein and water retention. She should take moderate protein diet.
She has been initiated on dialysis recently. What really happens is that, once you are initiated on hemodialysis, gradually you start showing tolerance to it.
For more information consult a nephrologist online --> https://www.icliniq.com/ask-a-doctor-online/nephrologist
Patient's Query
Thank you doctor,
What is the prognosis (lifespan and quality of life) with home care peritoneal dialysis?
Hi,
Welcome to icliniq.com.
Peritoneal dialysis is considered one of the best modality of dialysis as it is very comfortable for the patient. But, we make sure that the person to whom we start on peritoneal dialysis is able to receive proper care as the chances of infection of peritoneal dialysis catheter leading to peritonitis and implant failure are very common.
As far as prognosis is concerned, the one who receives an adequate amount of dialysis with the perfect maintenance of blood pressure, calcium, phosphorus, and iron levels is expected to have a good lifespan.
The exact time I cannot predict as it varies from person to person. Having various other comorbidities like coronary artery disease makes a person lose the battle.
I have my patients who have been on peritoneal dialysis for 10 years and are still alive. However, my recommendation would be to look for a kidney transplant and take peritoneal dialysis until a transplant is arranged.
For more information consult a nephrologist online --> https://www.icliniq.com/ask-a-doctor-online/nephrologist
Patient's Query
Hello doctor,
Thank you for giving me the opportunity to ask another question. But you have done an outstanding job, so I do not have another for the moment. I do worry about the etiology of these incidences of sudden, "idiopathic" renal failure and suspect idiosyncratic drug reactions that no one wants to deal with because we cannot "prove" anything. In any case, thank you for your excellent responses and will be back in touch with any other questions.
Hello,
Welcome back to icliniq.com.
A few things are really not known. We always consider infection or autoimmune diseases as the reason but if we cannot find the reason, we call it idiopathic.
I wish her a speedy recovery. Feel comfortable to ask me if you have any query.
For more information consult a nephrologist online --> https://www.icliniq.com/ask-a-doctor-online/nephrologist
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Internal Medicine
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