Why was my mother advised for a plasma treatment after kidney dialysis?

Hi doctor,

My mother is admitted to the hospital and is being treated for granulomatosis with polyangiitis. Now, it is the second week after the doctor gave her a course of steroids for the first three days. They gave two kidney dialysis before her kidney biopsy, of which the result came back with 20% damage and the remaining 80% recoverable by taking Cyclophosphamide for several months.

She was also given an injection once every two weeks to help her vasculitis. The reason for me to write is to get some extra advice. The doctors also started a plasma exchange (a course of five) to aid the effect of the lung. As she had to cough up now and then (once to three times a day), some black spots grew on her tongue. I am concerned that they gave her kidney dialysis after her second plasma treatment. Is there any problem?

Kindly help.

Hi doctor,

Thank you for the reply.

I would like to ask if the black spots will stay on or grow bigger on the tongue while staying on Cyclophosphamide for several months? I understand that she has lung conditions because she has been coughing blood. The status of her lung has active bleeding. The plasma exchange treatment that she is given can help improve her lung condition, inflammation in the blood vessel or kidney and does it prevent her from relapse? I would also like to know, does bleeding in the lung always get treated by plasma exchange or in severe lung condition? And in what situation is kidney dialysis given before the plasma exchange? What difference does it make if it has not?

Kindly help.

Hi doctor,

Thank you for the reply.

Prior to the previous questions, and as things move on with my mother's situation after she was diagnosed with GPA vasculitis, the organs involved were the kidney and the lung. I have a few more questions to ask. She has been given three plasma exchanges and regular kidney dialysis (with a gap of seven days of no dialysis).

Last week, I was informed that my mother's kidney condition is 30 % damaged with 70 % fresh injuries. I would like to know why there is an increase of 10 % in kidney damage while she is on strong steroids to treat her kidney failure, and has had kidney dialysis 3 times a week while she is in the hospital. Is it because her GPA vasculitis is not suppressed and still has an ongoing effect on the kidney? How long does a standard patient take to suppress the condition of GPA vasculitis?

Please guide.

Hi doctor.

Thank you for the reply.

Would that mean the ongoing GPA vasculitis is still not under control? It will continue to damage more of her kidneys for permanent damage, even though she has been having kidney dialysis 3 times a week. Does kidney dialysis actually help her recover from her fresh injuries or just help to remove the toxins that build up when it does not function?

Would there be a possibility that her kidney would not even recover a small percentage, like 30 % to 40 %, at all under these circumstances? If yes, when will we recognize this situation? What is the longest period that she can stay on the steroids for this kind of treatment? Will there be a situation when GPA vasculitis can never be suppressed? When her GPA vasculitis forms a relapse, will it damage her kidney or lung again as it has now?

Please guide.

Hi doctor.

Thank you for the reply.

This week I have queries on water retention on her legs. Though she had scheduled for 3 dialysis a week, each session varied from 2.5 to 4 hours. The doctors are saying that my mother is building too much fluid under her skin tissue due to not enough urine output in the ratio of intake of drinking water. They have been monitoring her for the last seven days. She was drinking 1.7 to 2 liters a day with urine output at under 600 ml. The everyday recording was very similar. They asked her to reduce her drinking to 500 ml to help her to detain the water retention to improve so she is fit enough to be discharged.

Since she has been only drinking 500 ml a day, her urine output is below 200 ml. Is this normal? What is the average urine output for a healthy person (2 liters a day)? Do all kidney patients have similar conditions on collecting too much fluid at the start? Is it because her kidney function has declined since in hospital (10% increase) and is this symptoms of its cause? Previously I mentioned that there was a period where she was not given dialysis for 7 to 8 days, could that be the catalyst to her ongoing build-up of water retention underneath her tissue?

Please guide.

Hi doctor,

Thank you for the reply.

I have attached the reports. My mother was discharged after three months. She is recovering now. Previously, she underwent dialysis three times a week. It has been reduced to twice a week for two months. Her doctor told that it will be reduced to once a week. Does this indicate recovery? Should she modify her diet? Currently, she is on a low-phosphate and low-sodium diet. Her CT scan shows lung scarring. She was prescribed the tablet Co--trimoxazole.

Will this affect GPA vasculitis? She started a new treatment plan before recovering from MMF, which lasted for three months. She has symptoms like breathlessness and bad breath with an ammonia taste for the past nine months. Should she be concerned? Provide me with details about the normal hemoglobin level, WBC, and platelet count. There was a variation in her sodium level. Her blood pressure is 76/46 mm Hg with the pulse rate of 124 beats per minute.

Please guide.

Hi doctor,

Thank you for your reply.

What are the other investigations to be carried out for her? Her report mentions a hemoglobin level of 100 g/L. Please explain. How does a patient with vasculitis differ from a normal person? What are HGB, WBC, PLT, URE, CRE (EGRE 11), NA, POT, BIC, CCA, PHOS, PTHI, ALB, BIL, AST, ALP, and GGT?

Please guide.