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Denisefh

Kidney Failure and Arrhythmias

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My poor cardiac function has caused me to have elevated Creatinine which is an indicator of Kidney failure. This has been ongoing for the past couple of years but has increased to the point where I have to have a Kidney Ultra Sound today.

 

One of my doctors finally gave me a medical term for the problem: Hypoperfusion. My Nephrologist has explained the problem more than a few times, but I never really understood, so at least now I have a name for it.

 

 

Prerenal Azotemia

 

First, there are prerenal conditions, often referred to as prerenal azotemia, a physiological response to renal hypoperfusion in which the integrity of renal tissue is preserved.[2] In this situation, a decrease in renal function is secondary to a decrease in renal blood flow. Because blood flow is inadequate, filtration is less effective.

 

These conditions account for about 70% of all instances of acute renal failure and about 50% of cases of acute renal failure in hospitalized patients, and the cause can be just about any state that causes decreased blood pressure or blood volume to be delivered to the kidney. This includes blood loss from a hemorrhage, hypotension, decreased blood flow resulting from decreased cardiac contractility (as in a myocardial infarction or severe congestive heart failure), or cardiac arrhythmias.

 

Prerenal azotemia should be suspected whenever serum creatinine rises in patients with a recent history or clinical evidence of " true" hypovolemia (eg, hemorrhage, vomiting, diarrhea, diuresis, burns, hyperpyrexia) or decreased " effective" circulatory volume (eg, cardiac or liver failure, nephrotic syndrome, sepsis). The classic urinary sequelae include low urinary flow rate and salt and water reabsorption from urine, leading to a concentrated urine, low urinary sodium (<10 mmol/L) and fractional excretion of sodium, and a benign urine sediment containing transparent hyaline casts. Definitive diagnosis of prerenal azotemia rests on rapid recovery of glomerular filtration rate after the restoration of renal perfusion.[3]

 

In all prerenal conditions, it is important to make the distinction between kidney function that resolves when perfusion is restored (eg, increasing fluid intake or correcting the source of hypotension) and kidney function that is severely impaired due to long-term hypoperfusion. In the latter scenario, after a prolonged period of ischemia, renal tissue is damaged and patients develop so-called intrinsic renal failure. That's why it's usually important to recognize prerenal acute renal failure -- it's reversible, but only if you correct it early.

 

Anyway, it's important for anyone with decreased cardiac function to have their Creatinine level checked routinely so their Kidneys can be assessed.

Denise

 

 

 

 

I cut and copied this from an article on Medscape, the entire article can be found at:

http://www.medscape.com/viewarticle/414667_4

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Great and important article Denise : :common076[1]:

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THis is excellent information Denise! Thank you! And good luck on your kidney ultra sound. Let us know when you get the results of the test. :wub: Hugs, Pat

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Kind of selfish question here but does anyone know what effect very low blood pressure would have on a person? I know - pass out or feel light headed. But our daughter has been having consistently low BP during her pregnancy. It usually is a bit on the low side but an example would be yesterday - 88/46. In the beginning she was passing out. Now she's on bed rest and can only get up to go potty. Still, that seems awfully low for someone who's awake, alert and eating well. Do you think it will affect the unborn child? Poor perfusion or whatever?

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Pat, my kidney US turned out okay. So far there are only labs that are off and no structural signs.

 

Irene, what does your daughter's doctor say? I found this on Suite101: http://prenatal-health.suite101.com/articl...uring_pregnancy

Other places I looked at said that it is common for a woman's BP to drop during pregnancy, but they were only talking about 10-15 points and not as much as your daughter's seems to have dropped.

 

Let us know what the doctor says. I'll keep her in my prayers.

Denise

 

(Actually I was wondering about you and the hypoperfusion thing. You have so many arrhythmias and have said you have swelling [i do too, but don't know if the swelling is due to the kidney stuff]. I hope your doctor has checked your Creatinine).

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I haven't had any blood work done for awhile. My doctor asks how my heart is doing and I say it's fine, just the same old stuff. She counts on me to tell her if anything has changed. I prefer to drop it.

 

I'll check that link about pregnancy.

 

I think my feet, ankle and lower leg swelling is just old age and times when I've eaten crummy food. Since I've been taking care of my Mom so much more this past year, I end up eating out twice a week and I hate it. There's nothing "good" about Olive Garden, Taco Bell, Carl's Junior, etc. They're all high sodium. I try to get away with eating very little but it doesn't take much of that stuff and by evening I feel like I'm wearing a water bed.

 

My arrhythmias aren't so bad. I started on the Diltiazem again a couple months ago to deal with some mysterious chest pains. That's helped a lot. I still get arrhythmias every day, mostly ectopics all day and some brief tachy times. The other night my heart went tachy for no reason, lasted about 10 minutes and shut off. That's such an improvement from years ago.

 

I'm glad your kidney US was clear. That's great news. Are they going to keep checking your creatinine levels now and then?

 

irene

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I've been going to this Nephrologist for over two years, ever since I was referred by my primary care. He's been checking it every few months all this time. The creatinine has been too high all this time, but fluctuates and this last test was the highest it's ever been. I had to have a kidney US back when I first saw this doc, and after this spike he was worried that a kidney was blocked (from a clot) or maybe something else was going on so that's why he ordered this US.

 

The high creatinine has something to do with the fact that the heart isn't able to pump the fluids around like it should and the kidneys react to not getting enough fluid by overworking and creating something (I guess the Creatinine). The kidneys get damaged and they lose their efficiency. I don't have any symptoms and wonder sometimes why I have to see him but apparently they're trying to stay on top of any worsening of the kidneys. He said what percent of normal mine are working at, but I can't remember the number.

 

You might ask your doc about compression stockings. I don't wear mine as often as I should, but surely do when I go on the treadmill. It helps my heart do the circulating in my legs. A diuretic (with Potassium) helps a LOT.

Denise

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That is good news about your kidney US Denise. Glad to hear it. Sorry you and Irene have the swelling in your legs and feet. That has to be uncomfortable too. Glad you arrythmias aren't as bad as they use to be Irene! I have an occassional PVC now since I had my ablation but it is just nothing more than annoying. They are far and few in between and never last long, thank goodness! Hugs, Pat

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