Background: End-stage renal disease (ESRD) represents the
terminal phase of chronic kidney disease (CKD), characterised by irreversible
loss of renal function requiring renal replacement therapy. Patients with a
solitary functioning kidney face unique challenges when progressing to ESRD,
particularly when multiple comorbidities are present.
Case Presentation: The clinical course of a 49-year-old
female with ESRD and a solitary kidney who developed numerous life-threatening
complications, was presented. The patient had undergone right nephrectomy two
decades prior and presented with severe uremia, anuria, and multisystem
involvement including hepatic dysfunction, haematological abnormalities, and
cardiopulmonary complications. Despite regular hemodialysis and comprehensive
medical management, she experienced recurrent pleural effusions requiring
multiple interventions, along with persistent electrolyte disturbances and
severe anaemia.
Clinical Findings: Laboratory investigations revealed
markedly elevated serum urea (110-190 mg/dL) and creatinine (8-13 mg/dL)
levels, with a glomerular filtration rate of 8 mL/min. Imaging studies
demonstrated bilateral massive pleural effusions with septations, and abdominal
ultrasonography showed moderate to gross ascites with splenomegaly. The patient
also exhibited pancytopenia, hyperkalemia, and hemoptysis, requiring intensive
multidisciplinary care.
Management and Outcome: The patient received bi-weekly to
tri-weekly heparin-free hemodialysis through an arteriovenous fistula,
supplemented with erythropoietin therapy and blood transfusions for refractory
anaemia. Tube thoracostomy and therapeutic thoracentesis were performed
repeatedly to manage recurrent pleural effusions and associated respiratory
distress.
Conclusion: This case underscores the significant clinical
challenges encountered in managing ESRD patients with a solitary kidney and
multiple comorbidities. Early recognition of CKD, timely initiation of renal
replacement therapy, aggressive management of complications, and patient
education remain critical components in improving outcomes. The case highlights
the importance of integrated multidisciplinary care and the need for heightened
awareness regarding CKD progression in high-risk populations.
Author(s) Details
Vinay Singh
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v1/6543
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