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Can Bladder Catheter Cause Sudden Decline In Renal Function?

Posted on Thu, 13 Aug 2015

Question: mom went into the hospital two months ago with an EGFR of >95. Gradually her kidney function reduced until now it is 12. She has had months of antibiotics and steriods. Now she is on bumex drip. is there anything else that can be done. I've heard about NAC and NAC amide. Could her bladder catheter be causing problems. She is putting out about 35 an hour, but creatinine is 3.5 bun 108
Thanks

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

I understand that there has been a sudden decline in renal function. However in order to help you I need more information

1. Is your mother a diabetic or a hypertensive?
2. Please let me know her urine routine and complete blood count along with ultrasound of the kidneys?
3 . Was any biopsy of the kidneys attempted?
4. Why was she given antibiotics and steroids? What was the diagnosis?
5. Is she able to pass urine on her own? Why is a bladder catheter placed?

Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (31 minutes later)

1. Neither 2. Routine? WBC 11.3 RBC 3.10 HGB 9.8 MCT27.7 MCV 87 MCH 30.7 MCHC 35.4, RDW 22.2 Platelet 106.
3. no biopsy. 4 antibiotics for sepsis/ steroids for low cortisol
She passes urine on her own. The catheter is because she became very weak.

could the catheter be causing blockage?
Could supplemental NAC cause a false high creatinine?
What should I be asking for? Ultrasound of kidneys?

Sodium 11 potassium 5.5
Chloride 89 CO2 17

Anion Gap 11, Glucose 109
Bun 108 Calc Osmoiality 279
Bun?creat Ratio 31
Calcium 7.6
Thanks

Answered by Dr. Rakesh Madhyastha (14 hours later)

Brief Answer:
Sepsis induced acute kidney injury

Detailed Answer:
Hello

Thanks for getting back

Here are my suggestions

1. Bladder catheter could be causing problems where it can cause urinary tract infection. I suggest you to send a urine culture immediately and change to silicone based bladde catheter
2. I also suggest you to get a ultra sound to know the kidney size. If the kidney size is normal then I recommend you to get a kidney biopsy done to see for reversibility of the kidney injury. If the biopsy shows good amount of normal kidney tissue then you don't need to worry about it
3. nac should not cause kidney problems it actually protects the kidneys
4. Please watch out for drop in urine output, make sure it is more than 600 ml per day
5. avoid pain killers
6. make sure she does not take red meat and follow a low salt diet
7. if there is swelling of feet and face restrict fluid to less than 1 litre per day

I hope I was of help, if you have any further queries please get back

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (8 hours later)

Dr. Madhyastha
She hasn't produced any urine yet today. I asked them to remove the XXXXXXX and they did. They are refusing to do an ultrasound. can dialysis remove third space fluid. Albumin doesn't seem to be moving it and she is seeping through the arms and legs. Is there anything she can take to encourage the kidneys. Bumex doesn't seem to do anything. Help thankyou.

Answered by Dr. Rakesh Madhyastha (14 minutes later)

Brief Answer:
Plan of action

Detailed Answer:
Hello

Thanks for getting back

If I were to be your doctor this is what I would have done

1. Stop Bumex drip and start a combination of Furosemide drip and oral Metalozone. This will decrease the edema
2. Check her weight everyday. A loss of 1 kg per day is sufficient
3. If the edema is still not better and urine output is less than a litre I would take her up for dialysis
4. Albumin can be given during dialysis

Please ask them to send a urine routine and urine culture atleast if not an ultrasound

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (39 minutes later)

thankyou
Her blood pressure is now low and supported by nor epiniphrine. There hasn't been any urine. Do the kidneys worsen by the inacitivty. How long can a person go without producing urine. I'm trying to get to a different hospital. They are refusing dialysis saying her blood pressure would get too low.

Answered by Dr. Rakesh Madhyastha (2 minutes later)

Brief Answer:
Sled

Detailed Answer:
Hello

Low blood pressure is harmful to the kidneys. When the blood pressure is low they can modify and do a sled known as slow low efficiency dialysis, however the blood pressure needs to be atleast 90 systolic.

Regards

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar