Hello doctor, A healthy 60-year old woman walks seven miles a day and has no underlying illness (autoimmune, cardiovascular, cancer, etc) very suddenly develops renal failure over about one month that doctors at the general hospital diagnose as microthrombotic angiopathy and hemolytic uremic syndrome. Creatinine of 7, Hb 7.1. She does not seem to respond to plasmapheresis or dialysis well. Has 4+ pitting edema in hands, arms, legs, feet. BP 190/84. She has had three sessions of hemodialysis over five days. She is very nauseated. The patient believes that she began to be sick after she changed from brand name Osteocalcin (salmon) spray to a generic form. Do you think she could be having an idiosyncratic reaction to the fish calcitonin which has been stopped?
Hi. No, changing the brand is not a reason to develop microangiopathy and HUS (hemolytic-uremic syndrome). She needs to be convinced to accept what has happened. She would require hemodialysis sessions thricea week with adequate diuretics. The pedal edema is mostly because of low protein and water retention. She should take moderate protein diet. She has been initiated on dialysis recently. What really happens is that, once you are initiated on hemodialysis, gradually you start showing tolerance to it. For more information consult a nephrologist online -->