What’s Wrong With Me?

Reader's Digest (Canada) - - Contents - LISA BEN­DALL

A med­i­cal mys­tery re­solved.

THE PA­TIENT: Saman­tha*, a 24-year-old wait­ress

THE SYMP­TOMS: Lower back pain

and ex­haus­tion

THE DOC­TOR: Dr. An­drew Rule, nephrol­o­gist at the Mayo Clinic Hos­pi­tal, Rochester, Minn.

SAMAN­THA, A WAIT­RESS who spent most of her days on her feet, hardly ever got sick. But in Oc­to­ber 2017, she started feel­ing rot­ten. She was tired all the time and be­gan to won­der if she had the flu. At the res­tau­rant, she just wanted to crawl un­der a table. Her reg­u­lars could tell some­thing was wrong.

Dur­ing this pe­riod, Saman­tha also felt an in­ter­mit­tent, stab­bing pain on the right side of her lower back. She no­ticed her urine looked cloudy, which made her sus­pect a uri­nary tract in­fec­tion—or, worst case, a kid­ney stone.

When noth­ing re­solved after two weeks, Saman­tha vis­ited her fam­ily doc­tor, who checked her urine. She was neg­a­tive for a UTI, so the doc­tor took some blood and sent Saman­tha for a CT scan of her kid­neys.

The next day, the doc­tor called to tell her there was no kid­ney stone, but that Saman­tha’s level of cre­a­ti­nine, a waste prod­uct, was ris­ing. Also, her urine con­tained blood and pro­tein. Un­able to ex­plain it, Saman­tha’s doc­tor re­ferred her to the Mayo Clinic’s emer­gency depart­ment.

Nephrol­o­gist An­drew Rule as­cer­tained from ad­di­tional blood tests that Saman­tha’s kid­neys were los­ing func­tion rapidly; he guessed that some­thing could be caus­ing in­flam­ma­tion of her glomeruli, net­works of tiny blood ves­sels in the kid­neys that help fil­ter waste. Rule or­dered new

tests to look for pos­si­ble causes, such as lu­pus, and gave Saman­tha a high­dose steroid to con­trol in­flam­ma­tion. “Time is crit­i­cal for kid­neys,” he says. “If they stop work­ing, they may not come back.”

Rule dis­cov­ered that Saman­tha’s blood con­tained an­ti­bod­ies, cre­ated by her own im­mune sys­tem, that were at­tack­ing the glomeruli. When this hap­pens, these clus­ters of frag­ile blood ves­sels in the or­gan break down and bleed. If the prob­lem isn’t treated soon enough, pa­tients not only lose their kid­ney func­tion—they can lose their lives.

The rare con­di­tion, known as anti-GBM dis­ease (named after the an­ti­bod­ies), oc­curs most of­ten in peo­ple who are in their 20s or over 60. Doc­tors re­main in the dark about the rea­son for this age split, and about some other as­pects of the dis­ease. “It’s not known what trig­gers these an­ti­bod­ies to be pro­duced in the first place,” says Rule.

Treat­ment, which must be­gin right away, in­cludes steroids, chemo­ther­apy and some­times rit­ux­imab, an an­ti­body ther­apy. On top of this, Saman­tha’s blood would be re­moved each day to fil­ter out the plasma with the dam­ag­ing an­ti­bod­ies, and then re­turned to her veins along with donor plasma.

After seven days of this reg­i­men, Saman­tha’s cre­a­ti­nine lev­els hadn’t nor­mal­ized, so she be­gan dial­y­sis— three ses­sions a week—to do the work of her im­paired kid­neys.

Eigh­teen days later, the an­ti­bod­ies had low­ered enough for her to go home. She would con­tinue dial­y­sis but even­tu­ally, doc­tors told her, she would need a kid­ney trans­plant.

Then, a cou­ple days be­fore Christ­mas, she got won­der­ful news that came as a com­plete sur­prise: not only was the treat­ment per­form­ing well, and the an­ti­bod­ies’ as­sault on her kid­neys eas­ing up, but some func­tion had re­sumed. “None of us ex­pected that,” says Rule, ex­plain­ing that while many of Saman­tha’s glomeruli were da­m­aged be­yond re­pair, oth­ers had must have started work­ing ex­tra hard. She no longer needed dial­y­sis, let alone the trans­plant.

To­day, Saman­tha is back at work. Although her kid­neys will never be com­pletely nor­mal, she does her best to keep them healthy by watch­ing her in­take of salt and potas­sium. “I had about 40 peo­ple of­fer­ing me their kid­neys,” she says. “But I didn’t want theirs—I just wanted mine.”

“If kid­neys stop work­ing, they may not come back,” says nephrol­o­gist An­drew Rule.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.