Liz Lightstone

Just back from 3 weeks away. Apologies but going to take some time to catch up with emails - if your query was urgent please resend it.

I’m sorry to hear you have suffered an acute kidney injury. It is very possible to recover but it does entirely depend on the cause. If you simply became dehydrated and dropped your blood pressure (e.g. with a bad infection, after trauma etc) and your kidney function was normal before, then it’s very likely you will recover. If there is a problem directly affecting the kidney then it will depend on what that problem is and getting the specific treatment. I hope all goes well.

Generally in too many meetings most days. I will try and reply as promptly as possible but please excuse delays

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The current advice for patients with kidney disease about coronavirus and COVID-19 vaccination for patients is on the Kidney Care UK website https://www.kidneycareuk.org/news-and-campaigns/coronavirus-advice/

It depends on how poorly she was, whether she was dehydrated, and whether her blood pressure dropped. I would recheck a week or so later to ensure it has settled back to baseline.

The problem with "natural medicine" is that it is unregulated, untested and we have no idea what it does. I'm not sure what treatments have been recommended for him but they will all have been evaluated for the efficacy and tested extensively. Yes "ordinary" medicines can have side effects but his doctor should be able to explain any of these to him. Of course it entirely depends on what his kidney disease is and what treatments he needs. But just because something is "natural" does not mean it's safe or of benefit.

This is a tricky one. It very much depends on her kidney disease and how bad it is. Often with severe kidney problems you need to restrict your fluid intake but if hers is mild it may be fine. The real issue is why is she drinking so much - does she have excessive thirst, has her blood sugar and her calcium levels been checked? Why is she drinking more for "health" reasons? She won't harm her kidneys by drinking a lot but she might find she gets some swelling of her ankles if her kidneys can't cope with the volume and it's possible she could lower her sodium in her blood if she really drinks a lot.

Kidney function at 14% of normal in a very elderly patient - I'd focus on excluding easily reversible causes (obstruction, infection etc) and then my main focus of care would be on symptom control (treat anaemia with erthyropoeitin if indicated), ensure not fluid overloaded, and establish her goals and wishes vis a vis end of life care. Generally I would not recommend dialysis in this age group as unlikely to prolong life but could adversely affect quality of life. I would be interested in rate of change of function. I would ensure kidney toxic drugs avoid (especially NSAIDs), advise regarding fluid status and be aware that an intercurrent illness (e.g. a cardiac event) likely to lead to end stage kidney failure. Long term prognosis guarded but can be meaningful if remains well.