Post-Surgery Kidney Failure: A Case Study in Diabetes

Post-surgery

My mother-in-law, who is 70 years old and has had diabetes for 8 years, recently underwent hip surgery.
However, post-surgery, she developed renal failure.
The doctor informed us that she would need dialysis, even though she did not require it before the surgery.
Why did she need dialysis after the operation? During her hospital stay, she underwent dialysis twice and was discharged with a urinary bag.
However, six days later, she developed pulmonary edema.
I would like to know if surgery can lead to renal failure.

Additionally, why did my mother-in-law, who did not need dialysis before the surgery, experience such complications afterward?

Zhang, 30~39 year old female. Ask Date: 2004/04/04

Dr. Ke Zhengchang reply Internal Medicine

Hello, diabetes can potentially lead to renal dysfunction.
General anesthesia during surgery may also contribute to the deterioration of kidney function.
Additionally, the use of analgesics, antibiotics, or conditions such as anemia, continuous bleeding, and shock can result in renal failure and pulmonary edema, necessitating dialysis.
This is particularly common in the elderly and often occurs unexpectedly.
The specific circumstances should be explained by the attending physician.
Thank you.

Reply Date: 2004/04/04

More Info

The situation you described regarding your mother-in-law's post-surgery kidney failure raises several important points about the relationship between surgery, diabetes, and kidney function. It is crucial to understand that while diabetes can lead to chronic kidney disease (CKD), the acute changes in kidney function following surgery can be influenced by various factors, including the patient's pre-existing conditions, the nature of the surgery, and the overall management during and after the procedure.

Firstly, diabetes is a significant risk factor for kidney disease. Over time, high blood sugar levels can damage the blood vessels in the kidneys, leading to diabetic nephropathy. This condition can progress to end-stage renal disease (ESRD), requiring dialysis or kidney transplantation. However, your mother-in-law had not required dialysis prior to her hip surgery, indicating that her kidney function was still relatively preserved.

The onset of acute kidney injury (AKI) following surgery can occur for several reasons. Surgical procedures, particularly those involving anesthesia and significant fluid shifts, can stress the kidneys. In patients with pre-existing kidney issues, such as those with diabetes, the risk of AKI is heightened. Factors that can contribute to AKI post-surgery include:
1. Hypotension: During surgery, blood pressure can drop, reducing blood flow to the kidneys and causing damage.

2. Dehydration: Inadequate fluid management before, during, or after surgery can lead to dehydration, further compromising kidney function.

3. Medications: Certain medications used during surgery, including contrast agents for imaging or nephrotoxic drugs, can adversely affect kidney function.

4. Infection: Post-operative infections can lead to systemic inflammatory responses, which may impact kidney function.

In your mother-in-law's case, the fact that she required dialysis shortly after surgery suggests that her kidneys were unable to cope with the stress of the procedure. The development of pulmonary edema and the need for intubation indicate that her overall health was compromised, which could be related to fluid overload or heart failure, conditions that can also arise from kidney dysfunction.

It is also essential to consider that while her diabetes was managed prior to surgery, the surgical stress and potential complications could have precipitated a rapid decline in kidney function. The medical team likely assessed her kidney function post-operatively and determined that dialysis was necessary to manage her fluid and electrolyte balance.

Regarding the insurance and liability concerns you mentioned, it is common for insurance companies to scrutinize pre-existing conditions when determining coverage for complications arising from medical procedures. However, the medical community recognizes that surgical interventions can lead to acute changes in health status, especially in patients with underlying conditions like diabetes.

In summary, while your mother-in-law's diabetes was a significant factor in her overall health, the acute kidney failure following her hip surgery likely resulted from a combination of surgical stress, potential fluid management issues, and her underlying health status. It is crucial to have open discussions with her healthcare providers to understand the specific reasons for her post-operative complications and to address any concerns regarding her treatment and recovery.

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