Second chance for the kidneys

Three weeks ago, I got my stents swapped out and the tumors are really starting to impinge on the ureters.  The urologist was able to get some stronger stents inserted but the right ureter is getting harder and harder to manage.  He got the stent in but almost had to admit me try and insert it from above.  I have little idea of how this is performed and will talk to him about it at my next visit but things are getting worse in that area.

The kidneys have really responded well to the obstruction being removed with my numbers returning to a more normal (for me) level.  The big number that you watch for in kidney function is the creatinine level. 18 months ago, I had a truly normal creatinine of 1.1 which then rose to 2.4 12 months ago, 4.2 6 months ago and then was 8.2 prior to my stent swap.

My creatinine has now fallen back to a more tolerable level of 4.4 which puts me at about 18% of full kidney function. My nephrologist plans on holding off on dialysis until I hit about 10% of kidney function or I start to have significant indications of blood poisoning.  This could be as soon as 2 months or it could be as long as 6 months as long as I don't have another obstruction or even potentially longer.  We will continue to monitor my kidney function as well as the effects of kidney failure for the near future.

There are several effects that we will consider.  First, the kidneys manage the level of electrolytes in your blood, most notably, sodium, potassium, and phosphorus.  My last blood test shows that these are all in spec so I don't have to do anything special with respect to my diet.  Second, the kidneys filter out excess fluid in the blood and then you excrete it in your urine.  An indication that this is not functioning is that you begin to have swelling in your extremities and your blood pressure begins to rise.  So far, this is not happening for me.  Finally, your kidneys stop producing erythropoietin, causing you to become anemic (low red blood cell count).

Living at almost 7,000 feet in Colorado Springs, people tend to have excessively high red blood cell counts and mine should be in the range of 12-13.  Mine are 9.2 which is quite low, even for someone at sea level, and we have been trying to stimulate the growth with extra iron supplements but to no avail.  So I now have a second thing in common with Lance Armstrong as I am starting to receive synthetic EPO to attempt to boost my red blood counts.

So, getting back to the dialysis I expect to receive, I saw a vascular surgeon this morning to find out the plan for getting access to support dialysis.  A few weeks ago, I also had ultrasounds to map my veins and arteries so they would know where and how to create an AV-fistula in my arm to provide dialysis access.  As it happens, I have 'miniscule' veins according the the vascular surgeon and this means that they are unable to create a fistula.

The backup option is to insert a graft between the artery in your arm and the larger vein in your armpit.  This is not a preferred solution because grafts have a greater chance of infection and have other complications compared to a fistula but it is our best option.  They will insert a tube of PFTE (Teflon, so I will really be slick!!!) between the artery and vein in my upper left arm.  Recovery will be minimal and the surgeon says, if it hurts, don't do it.  I will still take a couple of weeks off of hockey but will be back on the ice in June.

So, May 9th, I will have my second surgical procedure in a month to put in the graft.  This usually takes less than 90 minutes and they will perform it with two blocks (arm and shoulder) along with some twilight sedation to avoid carcinoid crisis.  I will get some percocet for the pain but plan on being back in the office on Monday the 12th after making sure my kids give my wife a proper mother's day!