Tales from the dialysis center: A very sad one

I started my nephrology unit posting a few weeks ago and I was posted to the dialysis center for a week.

The dialysis center is a very interesting place to be and so is the dialysis machine. I might just talk about the dialysis machine in another post.

A dialysis machine is a machine that helps to purify the blood in patients with kidney disease.

By [email protected] - Own work, CC BY-SA 4.0, wikimedia

When people have kidney disease, they are unable to excrete a lot of waste products and this leads to the accumulation of these waste products.

The dialysis machine functions in clearing the waste products.

The dialysis machine can be likened to the kidney.

About a week ago, I experienced one of the saddest experiences in my one year as a house officer.

I was called very early in the morning around 6 am by the nurses at the dialysis center and I was told there was an emergency at the dialysis center.

The nurses sounded agitated and so I brushed my teeth and rushed out of my room to the dialysis center.

I got to the dialysis center and met a very young beautiful girl with a swollen face struggling for her life.

She was breathing like she was drowning.

She took in very deep breaths with so much energy.
She was a beauty in distress and guess what? She was just 26.

At a point, she started gasping for air and when a patient starts gasping, the outcome is usually not good.

I asked the nurses if she was a regular or a new emergency patient.

She was a regular.

She had chronic kidney disease but this time she had acute pulmonary edema

Acute pulmonary edema is a condition in which a person's lungs is overloaded with fluids because the kidney isn't able to excrete it and so they present with sudden breathlessness.

It is usually described as one drowning in one's secretions.

I rushed to spin her PCV, her PCV was 18%.
This was too low to get her dialyzed.

We had to get her blood within one hour while giving her oxygen.

While waiting for the blood, she started turning on the bed and wailing.

I was confused and asked her the problem. She said her stomach was paining her.
She kept on crying.

There was nothing I could do as the stomach pain was a complication of the excess urea that was meant to be excreted by the kidney.

This condition is known as uraemic gastritis.
The only solution was to start her on dialysis and reduce the concentration of urea in the blood.

In one hour, the blood was ready and she was placed on the dialysis machine.
We removed about one liter of fluids first, to help her breathe properly and then we transfused her and then commenced dialysis proper.

She felt better after the 2nd hour and was back to normal.

I spoke to my Senior resident and while we talked he said the only solution to her condition is to have a transplant. However, she is low on funds and so she is being broadcasted on various TV stations for financial support.

He then told me something that melted my heart.

She was also in heart failure and he doesn't know how to tell her.

The implication of this is that she will be needing a heart and kidney transplant.

I went to my room and fell into tears.

I hope she survives this condition.

Take home

• Kidney disease can happen in any age group and so it is important to check one's kidney function regularly. I feel once in a year from the age of 25 years is fair enough.

• In Kidney failure, toxins accumulate in the blood and so they manifest in a variety of ways. However, one of the earliest signs is leg swelling and facial puffiness early in the morning.

• Urea is one of the most deleterious toxins that gets accumulated in the blood and is responsible for most of the complications fo kidney failure.

• The kidney is also responsible for the excretion of excess fluid from the body. When the kidney fails, there is an accumulation of fluid in the body.

• The fluid accumulates in the legs and manifests as leg swelling.
  It accumulates in the face and manifests as periorbital swelling- swelling around the eye

• It can also accumulate in the lungs and this manifests as breathlessness.

• There are different treatments modalities for kidney failure. Dialysis and kidney transplant are examples of the various modalities.

• Dialysis is a temporary treatment measure while kidney transplant is the definitive treatment.

• Having a kidney transplant requires a set of conditions to be met and one of the conditions that need to be met is a healthy heart.

That should be all for today.

Thank you for reading.

_{a picture of a patient with periorbital oedema}

By Klaus D.Peter, Gummersbach, Germany - Own work, CC BY 3.0 de, wikimedia