Kidney Issues: Insights on Recovery and Dietary Considerations

Kidney problems

Hello, my sister is 29 years old and has a history of refractory epilepsy for 23 years, is a carrier of hepatitis B, and has been diagnosed with schizophrenia for 2 years.
She was hospitalized on July 31 due to cellulitis and developed sepsis, requiring intubation in the ICU.
On August 7, her creatinine (Cr) was 0.43 (after starting a strong antibiotic), and on August 11, it increased to 0.9 (she was discharged from the ICU).
The subsequent creatinine levels were as follows: August 14 - 2.78, August 17 - 3.27, August 19 - 2.87, August 21 - 2.78, August 22 - 2.58, August 25 - 1.99, and August 28 - 1.58 (she was discharged to continue treatment at her original chronic disease clinic).
On September 7, her creatinine was 1.47, September 12 - 1.15, September 22 - 0.99, and October 5 - 0.93.
She experienced intermittent hematuria without proteinuria.
During the later stages of her hospitalization, she was prescribed steroids, but there was no explanation from the doctors regarding the reason for this treatment.
It is unclear whether the steroids were prescribed for the infection or for renal issues.
Initially, we were informed that her renal failure was not due to prerenal or postrenal causes.
At one point, the doctors suggested it resembled myocarditis, and later indicated it might be sepsis-related, but the underlying cause was not communicated.
When her renal function was severely impaired, she had a fever (around 37 degrees Celsius but felt very hot), developed rashes on her abdomen and lower back for two to three days (the nephrologist at that time did not believe the rashes were related to renal issues), experienced severe chills, abdominal pain, headaches, weight loss, polyuria (drinking about 2500 mL and urinating about 4000 mL without IV fluids), and nocturia (waking up to urinate three times, approximately 1200-1500 mL).
An ultrasound showed one kidney measuring 14.3 cm and the other 13.2 cm, with a 2 cm cyst.

The issue is that upon discharge, the doctor only prescribed medication for two days.
I did not initially notice the steroids because they mentioned a suspected autoimmune disease, and upon seeing the name of the medication as an immunosuppressant, I did not think much of it.
Therefore, after finishing the medication, she stopped taking the steroids (PLT 5 mg, 2 tablets).
Later, when consulting other doctors, they advised her to drink more water since her data was improving, and no additional medications were prescribed.
However, her recovery has been very slow, as indicated by the data above.
I later found information suggesting her symptoms closely resemble acute interstitial nephritis, and I am unsure if the initial prescription of steroids was intended for treatment.
Stopping the medication without knowledge may have contributed to her slow recovery.
After stopping the steroids, she experienced rapid heartbeat, severe weakness, and headaches, leading to an emergency visit.
Her renal injury has persisted for over two months; will this develop into renal failure? Currently, her electrolytes are normal, with mild anemia (hemoglobin 11.2).
She drinks 2000 mL a day and urinates between 1800-2400 mL, with daytime urination around 1000-1300 mL and nocturia of about 600-700 mL.
She is particularly careful with a low-salt diet and moderate protein intake.
I have resigned from my job to care for her and prepare meals at home.
Our family has been preparing takeout for her due to our mother's past death from liver cancer and our father not living with us.
If she is to start eating out again, what should we particularly pay attention to?
To summarize my questions:
1.
Did stopping the steroids without medical guidance affect her recovery?
2.
Is it possible for her renal function to recover to the level of 0.43?
3.
What should we be cautious about when eating out?
4.
With a serum iron level of 318, does she still need to take iron supplements?
Thank you, doctor, for taking the time to respond.

Li, 20~29 year old female. Ask Date: 2017/10/05

Dr. Wu Jiyu reply Internal Medicine

Based on the data you provided, this condition is classified as "acute kidney injury," which may be caused by cellulitis complicated by sepsis.
The key point is that as the infection is brought under control, your kidney function will gradually improve.
It is recommended to follow up with a nephrologist for ongoing monitoring.
Regarding dining out, it is advisable to avoid the "three highs" (high sodium, high fat, and high calorie).
Cooking at home is preferable.
Your blood iron level is 318, and there is no need to take iron supplements.
Thank you for your inquiry; the Nephrology Department at Changhua Hospital is concerned about your well-being.

Reply Date: 2017/10/05

More Info

When dealing with kidney issues, especially after a significant medical event such as sepsis or acute kidney injury, it is crucial to understand the implications of treatment choices, dietary considerations, and ongoing management strategies. Your family member's case presents a complex interplay of factors that can affect kidney recovery and overall health.

1. Impact of Stopping Steroids: The abrupt cessation of steroids without medical guidance can indeed influence recovery. Steroids are often prescribed to manage inflammation and immune responses, particularly in conditions like acute interstitial nephritis or other immune-mediated kidney diseases. If steroids were initiated to address an underlying condition, stopping them prematurely could lead to a resurgence of inflammation or other symptoms. It is essential to communicate with healthcare providers about any medication changes, especially with steroids, as they require a tapering schedule to avoid withdrawal symptoms and complications.

2. Kidney Function Recovery: The creatinine levels you provided indicate a fluctuating kidney function, with a peak of 3.278 and a recovery to 0.93. While a creatinine level of 0.43 is considered normal, it is essential to recognize that each patient's baseline may differ, especially in the context of chronic illness and reduced activity levels. Given your sister's history of chronic illness and limited mobility, her kidney function may not return to what is typically considered "normal." Continuous monitoring of kidney function through regular blood tests is crucial to assess recovery accurately.

3. Dietary Considerations for Eating Out: When transitioning to an external food environment, it is vital to maintain a diet that supports kidney health. Here are some key considerations:
- Low Sodium: Many restaurant foods are high in sodium, which can exacerbate hypertension and fluid retention. Opt for dishes that are grilled, steamed, or baked rather than fried or heavily seasoned.

- Protein Management: While protein is essential for recovery, it should be consumed in moderation. Focus on high-quality protein sources, such as lean meats, fish, eggs, and plant-based proteins, while avoiding processed meats and high-fat dairy products.

- Hydration: Encourage adequate fluid intake, but be mindful of any restrictions based on her kidney function. If she has been advised to limit fluid intake, this should be adhered to.

- Potassium and Phosphorus: Be cautious with foods high in potassium (like bananas, oranges, and potatoes) and phosphorus (like dairy and nuts), especially if her blood tests indicate elevated levels of these electrolytes.

4. Iron Levels and Supplementation: The blood iron level of 318 is within a normal range, but the need for iron supplementation should be evaluated based on the complete blood count (CBC) and ferritin levels. If her hemoglobin is low (as indicated by the 11.2 reading), it may be beneficial to consult with a healthcare provider about the necessity of iron supplements. They can assess whether her anemia is due to iron deficiency or other causes, such as chronic disease.

In summary, it is crucial to maintain open communication with healthcare providers regarding medication management, dietary choices, and ongoing monitoring of kidney function. Given your sister's complex medical history, a tailored approach that considers her unique needs and circumstances will be essential for her recovery. Engaging a registered dietitian familiar with renal nutrition can also provide valuable guidance in meal planning and dietary adjustments as she transitions back to a more varied diet.

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