« A diary of hospital life following a diagnosis of acute kidney failure »

Tuesday, 10th October 2006:

hmmm

Amlopipine dropped back down to 5mg a day.

Ultrasound taken at 9am. The right kidney looks fine now, though there is still some nephrosis to the left kidney, but greatly improved upon what it was. Hopefully it will recover in time.

Main history notes at the Royal

6/9/06 Diagnosis: ARF … Hydronephrosis

25/9/06 Cystoscopy and bilateral stent insertion (only right possible)

27/9/06 Nephrostomy on the left kidney

4/10/06 Stent insertion, left kidney.

Saw the urology team, led by the consultant, Dr Desmond. Subject to a satisfactory bladder scan I'm free to go, with tests to be arranged as an out-patient.

The end theory is that my HSP caused the ureters to dilate and/or the bladder is enlarged and causing problems and backwash due to high internal pressure. Just need a FRRS - 'Flow Rate Residual Scan' to check passing and bladder retention. Really not sure what that involves!

(As it happens you essentially piddle into a bucket and it measure the urine as the vessel empties. Then you have a bladder scan using a handheld portable ultrasound and the nurse calculates what's left.)

ANYWAY…
Going back to the urology scan, despite the fact he was in the nurses station on the ward the (junior?) doctor sent his instructions via a first year nursing student. I was only to drink water and not pass fluids until the scan at one o'clock. Given the nature of my condition 'holding on' for several hours really isn't an option and after forty minutes of agony while nurses chased this clown I gave up.
I should point out it was almost 5pm by then - not 1pm!
Sod's Law that the minute I come out of the toilets he (finally) turned up. Needless to say I roasted him - and I'll probably have another go at him tomorrow on the general principal that his ineffeciency set me back another day.
*Mutter*

Note to self: Scan on 9u

Recommended reading:

Saunders' Pocket Essentials of: Clinical Medicine (3e)
Publishers: Saunders
ISBN: 0-7020-2645-x
Points towards website: Flesh and Bones

(My) keywords, medical notes and understanding. Things to look up!
Urinary Tract Obstruction c.f. hydronephrosis
Bladder outlet obstruction
… retention with overflow and characterised by frequent passage of small quantities of urine.
c.f. antegrade uretography
cytoscopy
Pressure flow studies during bladder filling and voiding
Renal concentrating effect
Bilateral stents
Dilated ureters
Polyuria
ARF causes anaemia, nausea, vomiting

Neural…
Dizziness, faints and 'funny turns'
Postural hypotension occurs on standing in those with impaired autonomic reflexes… e.g. autonomic neuropathy.

Cataplexy (c.f. narcolepsy) condition in which sudden loss of tone develops in the lower limbs, with the preservation of consciousness - attacks are set off by sudden surprise or emotion.

c.f. Hypotonia

Bladder physiology (normal)
Intravesical pressure remains low as a result of stretching of the bladder wall and the stability of the bladders muscle (detrusor), which does not contract involuntarily

The sphincter mechanisms of the bladder neck and urethral muscles

Bladder and neurological causes
… accompanying neurological deficts (brainstem damage) may lead to incoordination of detrusor muscle activity and sphincter relaxtion, so that the two contract together during voiding This results in a high-pressure system with the risk of obstructive uropathy. Unlikey, but a consideration with regard to Dr Desmond's comments on possible causes and high-pressure in the bladder.