My Failing Kidneys

Pandan Indah Sky
Outside Hospital Pantai Indah, Pandan Indah – 4.15pm.

My kidneys are failing. That is an irrefutable fact. Their condition will only worsen with time. There is no way to determine whether the deterioration will be gradual or sudden. All I can do is to continue to be aware with the dos and don’ts of chronic renal failure and hope that their decline will be arrested.

When I was back in Penang recently, I did not have time to go for my scheduled check-up due this month. Since Wuan is on leave today, we spent almost the whole day at Pandan Indah. In the morning, I got my blood tested and had an ultrasound of my abdomen. In the afternoon, we saw Dr. Lim, the Physician and Nephrologist at Hospital Pantai Indah.

My serum creatinine had risen to 271umol/L from 258umol/U when it was tested in February. Although the calibration of the testing equipment of different laboratories varies, the serum creatinine count still shows an increase. My protein intake has to be further reduced in order not to strain the kidneys further. The three portions of meat that I was allowed is further reduced to two now.

Protein is needed to build, maintain and replace the tissues in the body. Protein provides the body with essential amino acids for such purposes. My low-protein diet, if not properly managed will result in protein depletion. This will cause a host of health problems from anaemia to osteoporosis. Symptoms for both are manifested in my blood tests and rippled finger nails called koilonychia.

Ketosteril was prescribed to supplement my low-protein diet with essential amino acids and Sangobion for my anaemia. Those are expensive drugs. One month’s supply of Ketosteril and Sangobion costs nearly RM600. That is not inclusive of Detrusitol that I am taking to relax my spasmodic bladder which is the cause of my renal failure in the first place. One month’s supply of Detrusitol costs RM170.

To cut down on the expenses for Ketosteril, Dr. Lim has suggested a “drug holiday” where I go without Ketosteril for Saturdays and Sundays. To maintain my protein intake, I have to increase it from 29gms of protein on weekdays to 36gms of protein on weekends. 36gms of protein will allow me three portions of matchbox-sized meat.

This progression is not something that I did not expect. Because of my spinal cord injury, I knew full well that renal failure will be one of the problems that I will have to come face to face with. Nevertheless, the thought that my kidneys may totally fail one day in the future is extremely unsettling. When that day comes, dialysis will be the only solution. That will be an expensive therapy and one that will restrict many aspects of my life. I pray that that day will never come.

Wisdom of the Domesticated Wild

Pets are more than mere companions. Over the years, Mum had kept dogs and cats. They were great teachers especially on instinctive survival at its most basic. They never ever whimpered or howled incessantly when ill. They would seek out their favourite spots and recuperate quietly there.

They seldom needed to see the veterinarian. One that did died. She was hale and hearty when we sent her in to have her ingrown nail problem treated. The vet gave her an injection and she went to dog heaven afterwards. He gave some lame excuses about her having a weak heart and all. Truthfully, it was more like she died of an allergic reaction to the antibiotics.

Pets are great teachers because they still listen to their own bodies. By observing them, I learnt a lot. Their domestication had not taken away those primal natures that are essential to their continued existence. They eat when hungry, sleep when tired and do everything else in between. I thought how wonderful it would be if I could listen to my own body just like them.

Emulate them I did the past week. I have been seeking my favourite spot to recuperate – my bed. I have been taking long naps in the afternoon. Those extended siestas were refreshing. I woke up with a slightly less dull mind and more vigour to carry me through to dinner for my next energy boost. The only drawback is that I have very little time for anything else.

In time, I hope my body will adapt better to Detrusitol and the diet. The side effects have become less apparent. I am slowly getting used to taking less meat and more meals. I am performing my intermittent catheterisation diligently and according to schedule. I have done my part. That is all I can do. The rest, I leave to God’s Providence.

Creatinine Alert


Detrusitol SR 4mg

There was a change in his demeanour from the usual. I thought he was perhaps thinking about his other patients’ problems.

“Have you been taking your Detrusitol?”

I mumbled a soft “Yes.”

“How often do you catheterise?”

“Every four hours.”

“Do you have any problems?”

I told him about the fever prior to the bloggers meet in KL.

“When you have a fever next time, come in for a culture. One day of infection is enough to wipe out your kidneys.”

I could only nod. I had a feeling that what he was to say next would not be good. He went on to say that my creatinine had shot up to 262 umol/l from the 180s. The normal threshold is around 100 umol/l. I was on the way to acute renal failure and he was really not happy with the figures. My kidneys, however, were not swollen, which meant that the intermittent catheterisation and Detrusitol are effective. I have to see the dietician again for my diet to be evaluated and revised. My protein intake of two servings per meal has to be reduced to one and one half. That is like cutting down to 75% from the two matchbox-sized portion of meat that I am allowed now.

“If that doesn’t work, you’ll have to go back to see what Dr. Liong can do for you further,” the dietician said.

This calls for another drastic change in lifestyle and dietary intake patterns. The dietician has also advised me to keep a diet log to track accurately what I have eaten. My medication was also changed. I am now to take one dose of 4mg Detrusitol SR just before bed. A one-month supply costs RM249 and it is supposed to be for the long-term. Detrusitol is prescribed for overactive bladder which may result in a reflux of urine back into the kidneys. I am still digesting this sudden assail of bad news. Hopefully the next review, which has been changed to quarterly from half yearly, will show better results.