Sunday, August 25, 2013

A Young Man Who Came In Smelling Like A Fish.....

Uraemia, [ end stage kidney failure,classic type ] presenting in the clinic smelling ' like a fish' usually now belong to the realm of old classic medical text book of medicine.  One such case walk into my Saturday morning clinic yesterday.
Mr AbdulRazak Aipojo, [ not his real name of course ],a 28 year Nigerian student attach to Taylor's came to see me with a complaint of easy fatiguability and frequent vomitting of two weeks duration. He has a sallow, pale complexion and smelt like a fish . Blood pressure was 220 / 130 !! [ normal for guys his age around 120 / 80 ].

' Young man, you need to be admitted..You BP is sky high and if we delay treatment, you will have a burst artery in the brain or you will have breathing difficulty plus plus..."

Always very difficult to persuade a young man of just 28 who thinks he has another 40, 50 years of life ahead of him. Adipojo is a candidate for sudden death which can come from a sudden cardiac arrest arising from a grossly disturbed electrolyte/ metabolic disturbance following impaired kidney function, a sudden stroke, or acute heart failure due to high bp and fluid accumulation in the lung.

His renal function test [ kidney function ] showed a serum creatinine of 2300 micromol/litre [ normal less than 115 ], an elevated blood urea of 55 [ normal up to 5 only ], and a potasium level of 5.1 [ normal up to 4 only, this potasium level is the one that predisposes to cardiac arrest ]

Uraemia is not my speciality. On admission, he was handed over to a nephrological colleague, who will institute urgent haemodialysis on a daily basis at first for a week or so. His bp need my urgent attention, of course.

This young man need to be on  long term kidney dialysis programme.
Life will never be the same for him, having to be hooked to a dialysis machine, 4 to 5 hours, 3 days a week 
End stage renal disease, oftentimes are quiet , insiduous disease than can surprise seemingly healthy looking people. Commonest cause is autoimmune inflammation of the kidney itself [ parenchymal kidney disease: glomerulonephritis, second commonest, due to choric untreated hypertension ]. In this young man, I think he had insiduous glomerulonehritis. The gross raised bp in him , in my opinion , is a sign of of his inherrent kidney dysfunction, rather than the primary cause. 
This is rather sad, at 28 !

From my vantage point, that is life.
Which somehow reminded me of death all the time
And I am not complaining. I consider this  frequent  reminder of the 'fragility of life', a priveledge.

Inna lillah hiwainna ilaihirojiun

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