help with acute renal failure - Kidney Disorders Message Board

dougd · 12-29-2003, 12:51 AM

2 weeks ago my brother (43) was found in his room by some of his friends. He couldn't open the door, walk or comunicate. They brought him to an emergency room. The doctor there thought he was having alcohol withdrawal. So he was pretty much ignored for about 12 to 24 hours. It was 30 hours after he arrived at the hospital before he was given dialysis.

As of today he cannot talk. He does open his eyes when asked. He is on a respirator. He has a blood infection and a mass on 1 of his kidneys. He has history of bladder problems which could have caused his kidney problems as well as the growth. A biopsy is going to be done tomorrow. I feel it will be a cyst and not cancer.

There area several doctors seeing him. They have all pretty much said that he is stable and in a little better shape than when he came in. However today one of the doctors told my mother that there is no hope for him. This is the same doctor from the emergency room.

If anyone has had-or knows of someone who has had similar symtoms, please let me know. I am not getting consistent information from the doctors.

Thank you.

butterflytrans · 12-29-2003, 11:28 PM

Okay...so they found a mass on your brother's kidney, which to be honest, I don't think is the reason for his renal failure.

There are numerous causes of acute renal failure, and they're grouped in to prerenal, renal and post renal...in other words, stuff happening before the kidneys, stuff happening inside the kidneys themselves, and stuff happening after the kidneys.

Prerenal (the most common)
is normally due to dehydration, but can also be from
increase in blood viscosity (multiple myeloma, polycythemia)
endogenous or exogenous toxins in the blood
renal artery stenosis
etc. etc.

Renal (less common)
glomerulonephropathies
acute tubular necrosis
interstitial nephritis

Post renal (less common)
This is mostly obstructive stuff like prostatic hypertrophy
bilateral ureteric obstruction...etc. etc.

Acute renal failure is usually not treated with dialysis...instead, it is treated by taking away the stress that is causing the renal failure...however, barring that:

Secondly.....

There are five indications for acute dialysis in a person who is not normally on dialysis:

confusion from increased waste products in blood (uremic encephalopathy)

inflammation of the covering of the heart due to increased waste products in blood (uremic pericarditis)

high potassium not treatable with medicine (intractable hyperkalemia)
high acid level not treatable with medicine (intractable hyperacidemia)

excess fluid volume not treatable with medicine (intractable hypervolemia)

renal failure due to toxins (methanol poisoning, lithium overdose, metformin overdose.....etc.)

These are basically things that happen that result in your kidneys being so messed up that you require dialysis to clear the wastes out of your blood:

The point that I am making by listing the above things is that, unless there was a gradual decline in your brother's function (which I don't think there was) the most likely explanation for his acute renal failure was some type of toxin in his blood. A tumour on his kidney, yes, can cause one of his kidneys to fail, but not both (unless he has the misfortune of bilateral kidney lesions which I don't think he does according to what you said). So what I think is that there is something missing from the history. Is it possible that your brother was on some medication or took some type of substance that might have been nephrotoxic?

What was he doing the night he was found lying there? Something just doesn't add up.

Did the doctors actually tell you what they thought the reason for his renal failure was?

dougd · 12-30-2003, 12:38 AM

Thanks for the reply.

More history & info:

My brother last talked to someone on a thursday. He told them he was not feeling well. After trying to reach him for 2 days my mother talked to a neighbor of his and this person wsent to his door. They heard him "throwing himself around his room". He did not answer them. They ended up breaking in to his apartment. This was on Monday. So he was sick for at least 5 days before he went to the hospital.

We found out today the infection he has is an ecoli-which they think came from his bladder since he has a history of bladder problems. He sometime needs a catheter to help him urinate. They are giving him antibiotics which are keeping his infection from getting worse but they have not found the source yet. He was dehydrated when he was brought in.

The biopsy was postponed today for the 3rd time because of "scheduling problems" and we are getting frustrated. Unless the cause of the infection if found and treated he will not recover. It is scheduled again for tomorrow if it does not happen again we will try talking to the hospital administator.

Thanks for the response.

butterflytrans · 12-30-2003, 12:22 PM

Sorry to hear about all of that! If you wouldn't mind, may I hear the results of the biopsy? This is just out of curiosity.

The fact that he often uses a catheter to urinate brings up the suspicion of urosepsis! I forgot to say that along with hypovolemia, another common cause of acute renal failure is a low flow state which can often happen with sepsis. The fact that it's E. coli raises even MORE suspicion that he probably has urosepsis.

dougd · 01-04-2004, 01:15 AM

Thanks again for your response.

They decided it my brother was not strong enough for a biopsy. On Thursday he was doing better and the doctors said that he has "turned the corner" for the better. He was taken off the respirator. However this morning my mother was called and told to come to the hospital because there was a problem. Apparently some tissue got stuck in his throat and stopped his breathing. He had to be intubated. He seemed to be stable when we got there. They took him for a cat scan of his brain, lungs and kidneys. When he returned he started to have seizures. He was given several drugs and they got a little better. The cat scan showed that he has bleeding in his brain and his brain is swelling-that is the cause for the seizures. Another cat scan will be taken tomorrow because sometimes if there is brain damage it takes a day or so to show up. My brother has always been strong, he has been through a lot in his life. I was not surprised when he started dong better and beating the infection. But now I don't know what will happen. We don't know how long his brain went without oxygen. I was a little concerned that when he went off the respirator that he only said a couple words and nodded his head.

I know I am rambling a bit but I cannot sleep.

Thanks again.