Dr. Sunil Prakash
Director & Sr. Consultant
Nephrology & Renal
BLK Centre for Renal Sciences
and Kidney Transplant
BLK Super Speciality Hospital
"Kidney diseases have reached
an epidemic proportion in India.
Early identification of cause and
/or associated complications
/co-morbidities and their
effective treatment may lead to
recovery of kidney functions in
these patients, thus obliviating
any further need of Diaylsis /
SAVING NINE WITHOUT A STITCH
A Story of How Kidney Failure Did Not
Lead to Dialysis or Transplant
Kidney failure is invariably synonymous to Dialysis or Kidney
Transplant. However, if intervened in time, many a cause of kidney
failure can be averted or recovered. This is of great importance to the
society at large as cost of Renal Replacement Therapy is well beyond the
means of many patients.
A 45 year old healthy CRPF jawan was admitted with a history of
moderate grade fever and joint pain for three days. He was experiencing
loss of appetite, nausea and vomiting along with haematuria. The
patient noticed diminution of urine and as a result, was referred to
Nephrology Department of BLK Super Speciality Hospital.
On consultation with the Nephrology team at BLK Centre for Renal
Sciences and Kidney Transplant, it was observed that the patient was
significantly uremic displaying symptoms of nausea, vomiting, acidosis,
fluid overload and uncontrolled blood pressure. The patient was
immediately taken for haemodialysis and stabilised. In view of his short
history of renal failure, normal kidney size, the diagnosis of acute
kidney injury was made. An ultrasound guided kidney biopsy was done
which was suggestive of Acute Interstitial Nephritis most probably due
to drugs. The patient was then treated with pulse steroids for 3 days
followed by oral steroids in tapering doses.
The patient has totally recovered his renal function, with his serum
creatinine level reduced to 4 mg/dL at the time of discharge and 1.2
mg/dL on follow up.
Acute Interstitial Nephritis is a renal condition causing renal
inflammation and decline in renal function. It is most often caused by
drugs. Virtually any drug could be the culprit but most commonly
implicated drugs such as Pantoprazole, Fluoroquinolones, anti
tubercular agents and some antibiotics. Timely diagnosis and treatment
is of paramount importance to reverse renal failure. It may otherwise
lead to permanent end stage renal failure requiring either lifelong
Dialysis or Transplantation.
High index of suspecting "Rapidly Progressing Renal Failure" (RPRF)
and losing no time in doing definitive blood tests and kidney biopsy
yields optimum results. Awareness and speed of management of RPRF
should be comparable to managing acute coronary syndrome.