Sudden development of low tolerance of dialysis in a young female patient

Extract

¹Chair of Nephrology, Department of Internal Medicine and²Maternal–Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Turin, Italy Email: [email protected]

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Case

A.A. is a 34-year-old woman with a presumptive diagnosis of chronic glomerulonephritis who has been on haemodialysis for 9 months. She was referred late to the Nephrologist, and dialysis was started within 2 months from referral, when she had a creatinine clearance of 9 ml/min, severe hypertension and anaemia. Low titre antinuclear antibodies and moderately depressed C3 levels also were present at referral.

At the time when she began having the problem under discussion here, A.A. was being dialysed twice weekly and in good metabolic balance, with an adequate equivalent clearance (EKRc) >11 ml/min, with a range of 14–16 ml/min [1].

Because of the increase in her residual renal clearance to 12 ml/min, she was allowed to switch to one dialysis session per week during the summer, permitting an easier organization of her vacation. Her adjunct therapy consisted of: doxazosin 4 mg/day, furosemide 125 mg twice a day, CaCO₃ 2 g/day, calcitriol 0.25 µg on alternate days and erythropoietin-α 4000 U/week. In the previous 3 months, she had been tested for the transplantation waiting list. No cardiovascular, pulmonary or immunological problems were detected.