Acute kidney injury within the context of CKD

[Athena]

I've received some clarity about my recent situation. My Neph has told me that my severe illness a few months ago as a result of being on high doses of progesterone-only hormone has caused an Acute Kidney Injury (putting me into Stage 4 from Stage 3). In the hospital they seemed to not establish any link between the two but I think it's a bit of a medical coverup. My GP recently post-fact has told me that the hormone drug has "androgenic and mineralocorticoid effects" which can cause electrolyte imbalances. But this is the same guy who, when I was suffering on this drug, told me the progesterone is 'safe' and dismissed my concerns about how bad it was making me feel!!! Doctors must really regard patients as stupid.

My Neph has told me he believes the hormone pill has caused my electrolyte depletion crisis but he can't prove it. He told me never to touch it again. He confirmed that I've had an AKI but because of the CKD, it is not certain that I will recover to former kidney function level. It was a bunch of gyno guys (young inexperienced doctors at another hospital) who put me on the progesterone as well as another potentially nasty drug called Tranexamic acid (which they were initially afraid to give to me due to my CKD but which my Neph approved), which set this negative path in motion.

I am angry and now feel like making a formal complaint. The medical system is so incompetent in dealing with patients with compromised kidney function & as a result will speed up someone's road to Dialysis quite easily without even a backward glance.

I only hope that I can recover from my AKI. My serum creatinine levels did drop a bit in my recent lab results last month. My Neph is a bit buoyed by that but remains pessimistic.

Any comments or opinions would be greatly appreciated.

[kristina]

Hello Athena,
I can't really comment on this because I have no experience,
but I wanted to let you know that I keep my fingers crossed
and hope that eveyrything goes alright for you.
Best wishes from Kristina.

[Athena]

Thanks Kristina. I appreciate your kind thoughts.

[PaulBC]

I'd be angry too, if I had suffered damage that was preventable. It's also an uncomfortable topic to bring up with your doctors. I think any doctor who isn't your nephrologist shouldn't be prescribing anything without clearing it first.

Other than that--because I really don't have experience or useful advice--I hope your kidney function returns. I completely understand your motivation for staying off dialysis, and hope you can find a doctor who shares it.

[UkrainianTracksuit]

Hi Athena,

I can't comment much about your exact situation (hormone induced AKI) but I have also experienced an AKI while suffering CKD.  It had a happy ending (at the time) so maybe you can have some hope.

Some years ago, I had one heck of a case of influenza.  I went to the emergency twice and stated that 1) I was Type 1 diabetic 2) I have severe renal impairment.  (Stage 4 at the time).  To make a long story short, they didn't request my nephrologists and the internists decided to treat things on their own.  One sign that the internists seemed to completely forget or disregard was that my urine output had dropped dramatically.  After some days hospitalization, my creatinine doubled (I don't remember exactly but I was hovering around 4), I developed severe edema and my kidney function had dropped considerably to eGFR ~ 12 %.  At the time, I had 26 % function so I was very shocked to learn I had dropped so low and my creatinine was higher than normal.  My nephrologist finally got involved and identified what had happened as AKI. 

I was informed that even with CKD that function can return.  Returning function didn't mean I would hit 26 % again but I was advised that I would reach around that area; they didn't know for sure as it was a "wait and see" game.  Secondly, it would take weeks or months before the function climbed back up to usual.  The renal team needed to keep an eye on it closely.  At the time, they told me the usual "if it doesn't increase after x amount of time, we'll make preparations for dialysis."  Naturally, I was very angry at the whole medical field.  How could they be so stupid?  Couldn't they get off their high horse and ask for help on an organ system that they weren't experts? 

I went for weekly blood work so my nephrologist could track the fluctuations of function.  One week, it was only up to 13 % and I figured, "The end is near." and then following that, I hovered at 19 % for awhile.  I still thought the end was near.  Two months after the influenza, finally, I was back up to 24 %.  Shortly after, back up to 26 %.  I didn't do much in the meantime but strictly follow the renal diet, take the required medications and had adequate fluids.  (Like you, there was a major electrolyte imbalance.)  The kidneys and body just needed its time to recover.  Boy, I sure wish it was that way for kidney scarring.

Again, like you I was warned that maybe damage from the AKI would permanently impact my function but I was lucky it returned.  Dialysis didn't come for some time after that.  I hope that you can bounce back to Stage 3 and I wholeheartedly agree with you about medical incompetence. 

Best of luck.

[Athena]

Thank you from the bottom of my heart for sharing that story UkrainianTS! That is exactly the sort of situation I am dealing with and I do feel hopeful knowing that it's possible to recover. I'm not dong anything differently either except taking my meds, eating a healthy salt-modified diet, exercising and just waiting.

Tomorrow I go to the hospital fior my pre-admission clinic meeting where they'll do labs and also I'll discuss my situation with my anaesthetist. I have a procedure scheduled the following week, called an endometrial ablation. It's a minor procedure but does involve general anaesthetic, doxycycline antibiotic for 7 days and analgesics after my surgery. I am scared stiff on a number of fronts, 1. What will my kidney function be tomorrow, 2. how will my kidneys tolerate the GA, 3. How will they tolerate the antibiotic and 4. How will they cope with the analgesics!

That's 3 new major enemy lines to confront!

I called my Neph for him to tell me what I can and cannot have but he told me that hospitals & anaesthetists have CKD well covered, particularly anaesthetists. I was not happy with my Neph being so lackadaisical. I am determined to refuse painkillers as much as possible. I will enquire about the possibility of having just local anaesthetic. My Neph said the doxycycline is quite safe for renal patients. But all in all, I am sure my kidneys would rather prefer not being exposed to all of this.

Another thing I discovered by way of medical incompetence is that ACE inhibitors should never be taken while there is illness involving dehydration &/or blood loss. I wasn't ever warned of this in the past. So what do you think happened? I was taking my high dose ACE throughout the whole period of traumatic blood loss as well as when I was dehydrated one time after food poisoning. Does the medical establishment really take kidney survival in CKD at all seriously?

As for the former hospital that prescribed the hormone drug and then left me unsupervised to continue taking it until it almost killed me - I will need to make a formal complaint against them. The hormone drug is contraindicated in diabetics with vascular complications as it is (doesn't that mean kidney disease?).

I sure will be questioning them very carefully tomorrow.

 

[KarenInWA]

I had a similar procedure to your endometrial ablation a year and a half ago, Athena. Mine was a uterine ablation (I think they're basically the same thing) and mine was performed in the gynecological office in their surgical room. I was not put under any anesthesia, all I did was take a prescribed dose of valium 5mg and 2 percocet before the procedure. That combination made me loopy and talkative. If anything, that drug combo made me entertaining to the dr and 2 nurses in the room! I don't remember taking any antibiotics, but I could just be remembering wrong (I'm a transplant patient). After the procedure, I bled quite a bit, and for the first 6 months or so, I had what I like to call "mini" periods. However, I have been period-free for months now, and I am so glad I did it!

Freedom from the feminine hygeine aisle is a good thing indeed! 

KarenInWA

[Athena]

Thanks for that Karen.
I think we are talking about the same procedure. Here in Australia they knock us out for that one but I think the surgeon said it's more like a sedative gas that's given. I'm a bit dismayed that there was bleeding for about 6 months after that. I can't afford any more extensive bleeding because it's really causing a lot of anemia & iron deficiency problems. Looks like I'll need to keep up with my Aranesp/ EPO injections for a little while longer if this happens to me.

Did you need to take a lot of painkillers after the procedure? I was told that there will be a day or two of cramping, like period pain, which is easily fixable with a little painkillers.

[KarenInWA]

I had heavy bleeding for the first 45 days or so, but everyone is different when it comes to the recovery. As for bleeding up to 6 months afterwards, that again is different for everyone, and mine was minimal. I only had to use pantiliners instead of pads or tampons. That's why I called them "mini" periods. It was waaaaay better than what I had before, that's for sure!

I have a high pain tolerance as it is, so I only took 2 pain killers after the procedure. I had it done on a Thursday and went back to work on Friday (desk job). I ended up sleeping a lot over weekend, though!

KarenInWA

Edited to add: The bleeding for up to 6 months afterwards was not continuous, it was regular periods that were "mini" periods. Just donned on me to clarify that!

[Athena]

Had my meeting with the anaesthetist today. Wow, what a meeting! These guys sure know a lot of things about the impact of drugs on the kidneys & the rest of the body. An anaesthetist turned Nephrologist with a special side interest in herbal pharmacology would be my ideal Nephrologist! Seriously! 

He told me that Tramadol is not recommended for kidney patients, because it does put a heavier load on the kidneys compared to other similar drugs. Similarly under no circumstance, would a NSAID ever be given to a kidney patient. He underlined that one quite clearly.

All drugs are metabolised and excreted by the liver and kidneys. Certain drugs, such as antibiotics, do involve principally the kidneys to excrete. Most drugs require metabolization by the liver, with the kidneys being left the task of excreting by products. By products may be inactive by products or active by products (the latter requiring more work for the poor kidneys).

My drug list for this procedure will be:

General Anaesthesia: Propofol & Fentanyl
Anti nausea meds: Dexamethasone & ondansetron
Paracetamol (Tylenol) may be sufficient after the procedure, otherwise if pain is more severe, Endome.

And now for the big one! My labs were done today and they will be available tomorrow! I see Neph 2 on Friday so no doubt will find out my latest labs then.

Oh the agony again of getting lab results!

[Athena]

WONDERFUL news today! My serum creatinine levels have dropped further this month and I am now back in STAGE 3!!!!  

Still a little bit more to go to get back in the higher 30s GFR. I sure hope my kidneys still have a bit more puff and steam to recover even more. It's just wonderful to get some positive news for a change on the dreaded creatinine levels. My prayers have been answered.

Woohoo!! 

I only pray that the recovery process will still continue as I undergo my minor surgical procedure with general anaesthetic and 3 days of antibiotic, doxycycline, next week.

[MooseMom]

Fantastic news, Athena!!!     I can feel your relief from here!!

[justagirl2325]

Very happy for you.

[PaulBC]

Great news! Hoping you get many more years of function out of your own kidneys.

[Athena]

Moosemum, Justagirl & Paul, thank you so much for your good wishes. I really appreciate it 

[UkrainianTracksuit]

Hi Athena,

I haven't been able to get online lately but CONGRATULATIONS!  I am so happy for you over your increase in function. 

By the way, I had a small procedure with some of the medications you listed.  In my pre-surgical appointment, the anesthesiologist assured me that when they deal with someone with CKD, they use medications and a pain regimen that are handled (sorry, late at night, my English is shut off) by the liver.  Post-surgery, my function was stable so I wish the same for you.

I hope for a continuation of good luck and best wishes!

[Athena]

Thank you dear UkrainianTS girl!
Well my surgery is only tomorrow. They've also told me that the GA & painkillers will be all relatively well tolerated by the kidneys. I will also be on a Sodium Chloride IV fluid after the op.
Can't wait for this surgery to be over & done with.
Take care

[Athena]

Well I've had my surgery about 30 hours ago. Boy, general anaesthetic felt like a mini-death! The Fentanyl was like a magical substance in post-surgery recovery. It dissolved the pain in an instant! Apart from a bit of Fentanyl immediately after surgery (which btw was a bit longer & a more involved ablation technique than originally planned), there has been no pain whatsoever since. I'm thankful that no painkillers have been needed so far. Apparently while I was still partially conscious, I was arguing with the recovery nurses about not giving me any analgesics. When I became fully conscious, I was in a bit of pain & the body was going into shock mode. Once I agreed to a bit of Fentanyl, it was instant painless calmness & the BP dropped to normal again.

KarenInWA, the bleeding is extremely minimal by now, almost nothing. Praying that it will soon cease completely. Surgeon told me it is normal to have a week of minor bleeding post surgery. But everyone's experience may vary. It's a nervous waiting game now.

I see the surgeon in 2 weeks time. The only thing that got me through this is the thought of how going through a hysterectomy would be far worse while recovering from drug-induced kidney damage!

Yay, no painkillers!