Acute Kidney Failure Recovery: Key Insights and Timeline

Q: Acute Kidney Failure Recovery: Key Insights and Timeline

Hello： Based on the information you provided, if kidney function was normal during the previous year's health check and has suddenly deteriorated this year, the clinical course should primarily be considered as acute kidney injury. <br>However, acute kidney injury can lead to var

Recovery from renal failure

Hello Dr.
Wu, in May of this year, I underwent blood tests due to feeling unwell.
The first test results showed BUN: in the 120s and Cr: around 5.5 (with no proteinuria present).
Two days later, I had another blood test, and the results were BUN: in the 130s and Cr: around 7.5 (with 3+ proteinuria).
The following day, I had a third blood test, and the results were BUN: in the 130s and Cr: over 10 (with 3+ proteinuria).
I then went directly to a large hospital for inpatient treatment and blood pressure management.
Upon admission, the same day's blood test showed BUN still in the 130s and Cr had risen to around 11.0.
After 10 days in the hospital, I was discharged and am currently recovering.
I would like to ask Dr.
Wu:
1.
Is the rapid increase in my Cr levels due to an overall acute kidney failure?
2.
The doctor mentioned it is acute but with some chronic features (as the ultrasound showed slight renal echogenicity), but all my tests from the previous year were normal (liver and kidney function indices were normal, and urine tests were also normal), so I find it hard to believe.
How long does it typically take for kidney function to recover from acute kidney failure? My attending physician said it would take at least six months.
(I have been recovering for four months now, with BUN: 32, Cr: 4.6, hemoglobin: 10.5, and urine protein-to-creatinine ratio of about 0.75).
3.
Additionally, during my hospitalization, my blood glucose levels were higher (around 105), can kidney failure affect blood glucose regulation? My previous fasting blood glucose tests were all below 100.

Thank you, Dr.
Wu, for your patient answers!

Niming, 20~29 year old female. Ask Date: 2016/10/02

Dr. Wu Jiyu reply Internal Medicine

Hello: Based on the information you provided, if kidney function was normal during the previous year's health check and has suddenly deteriorated this year, the clinical course should primarily be considered as acute kidney injury.
However, acute kidney injury can lead to varying degrees of chronic damage, similar to how a wound may scab and leave a scar; sometimes, kidney function may not fully recover.
Different causes of kidney injury will present differently and require different treatment approaches, with recovery times varying due to individual differences.
If you have been resting for more than three months but your creatinine level remains at 4.6, it indicates that your kidney function has sustained a certain degree of chronic damage.
Considering your age (22 years) and the occurrence of significant proteinuria during the course of your illness, it is recommended that you visit a nephrology specialist for follow-up treatment and to investigate the underlying causes of the kidney injury (such as less common causes like autoimmune diseases, infectious diseases, glomerulonephritis, etc.) to prevent further deterioration of function.
Additionally, while renal failure does not directly affect blood glucose levels, the underlying causes of renal failure may lead to abnormal blood glucose control, or hyperglycemia itself may cause further deterioration of kidney function.
If your current fasting blood glucose levels are within the normal range (<100 mg/dl), then this aspect does not have a direct impact on the kidneys.

Reply Date: 2016/10/02

More Info

Acute kidney failure, also known as acute kidney injury (AKI), is a sudden decline in kidney function, which can occur due to various factors such as dehydration, medication toxicity, infections, or obstruction of urine flow. In your case, the rapid increase in creatinine (Cr) levels indicates a significant decline in kidney function, which aligns with the diagnosis of acute kidney failure. The speed at which your Cr levels rose is concerning and suggests that your kidneys were under considerable stress, likely due to the underlying causes that led to your hospitalization.

1. Rapid Increase in Creatinine: The swift rise in your creatinine levels from 5.5 to over 11.0 within a short period is characteristic of acute kidney injury. This rapid change can occur when the kidneys are suddenly unable to filter waste products from the blood effectively. Factors such as dehydration, acute glomerulonephritis, or acute tubular necrosis could contribute to this condition. The presence of proteinuria (3+) further indicates that there is significant kidney damage, as healthy kidneys typically do not allow protein to leak into the urine.

2. Recovery Timeline: The recovery of kidney function after an episode of acute kidney injury can vary widely among individuals. While some may experience a complete recovery within days to weeks, others may take months or may not fully recover, especially if there is underlying chronic kidney disease (CKD). Given that your doctor mentioned a recovery period of at least six months, it suggests that there may be some degree of chronic damage to your kidneys, as indicated by the ultrasound findings of mild renal parenchymal changes. Your current BUN of 32 and Cr of 4.6, while improved, still indicate that your kidney function is not back to baseline. Continuous monitoring and follow-up with a nephrologist are crucial to assess your kidney function over time and to determine the best management strategies.

3. Blood Sugar Levels and Kidney Function: Regarding your question about blood sugar levels, acute kidney injury can indeed affect glucose metabolism. The kidneys play a role in glucose homeostasis, and when they are not functioning optimally, it can lead to fluctuations in blood sugar levels. However, your blood sugar levels of around 105 mg/dL are still within a reasonable range, especially considering that you have a history of diabetes. It is essential to manage your blood sugar levels effectively, as uncontrolled diabetes can further exacerbate kidney damage. Regular monitoring of your blood glucose, along with maintaining a healthy diet and lifestyle, is vital.

In summary, your experience with acute kidney failure highlights the importance of timely medical intervention and ongoing monitoring. It is essential to work closely with your healthcare team to manage your kidney health and any underlying conditions. Regular follow-ups, lifestyle modifications, and adherence to prescribed treatments will be key components in your recovery journey. Additionally, if you have any concerns about your kidney function or overall health, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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