Ms. Binh had been under the care of Doctor of Grade II Ta Phuong Dung, deputy director of the Urology - Nephrology - Andrology Center and head of the Nephrology - Dialysis Department, for three years. Her glomerular filtration rate (GFR) remained above 28 mL/min/1,73m² (stage 4), occasionally reaching 31 mL/min/1,73m² (stage 3b). Last week, she experienced fatigue and loss of appetite. Tests at Tam Anh General Hospital Ho Chi Minh City revealed her estimated glomerular filtration rate (eGFR) had plummeted to 6,7 mL/min/1,73 m², indicative of stage 5 kidney failure.

"This was the first time the patient's glomerular filtration rate dropped to such a dangerous low", said Doctor Dung. She diagnosed Ms. Binh with acute kidney injury superimposed on chronic kidney disease. This condition could lead to hyperkalemia, metabolic acidosis, fluid overload, uremic syndrome, and the risk of needing dialysis.

Typically, patients with a glomerular filtration rate below 10 mL/min/1,73 m² are immediately indicated for emergency dialysis. However, emergency dialysis, which requires a central venous catheter, carries a higher risk of serious complications compared to scheduled dialysis, which allows for an arteriovenous fistula. The doctor decided to treat Ms. Binh using a non-dialysis acute kidney failure protocol, opting for close monitoring.

The patient received fluid resuscitation tailored to her cardiovascular status and urine output. Doctors treated her electrolyte imbalances, controlled her blood pressure and blood glucose levels, and addressed a gastrointestinal infection. They closely monitored her potassium levels, metabolic acidosis, urine output, and fluid balance.

In the initial days, kidney function indicators remained at dangerous levels. The medical team faced multiple decisions regarding whether to insert an emergency dialysis catheter for the patient. However, Doctor Dung assessed that while kidney function had reached stage 5, the patient's ability to still urinate indicated a chance for recovery. Therefore, doctors continued to manage the acute kidney failure, prioritizing renal perfusion restoration, thorough toxin removal, and electrolyte imbalance control to prevent permanent kidney damage.

Ms. Binh receives results showing her kidney function has recovered to stage 4, avoiding dialysis. *Photo: Tam Anh General Hospital*

Ms. Binh responded well to the treatment protocol. Her glomerular filtration rate improved daily, and she gradually recovered, being discharged after one week of treatment. Her GFR had increased to 17,48 mL/min/1,73 m². During a follow-up three days later, her GFR reached 21,97 mL/min/1,73m², indicating her kidney function had returned to its previous stable level, with no need for dialysis.

Doctor Dung advised chronic kidney disease patients to consume thoroughly cooked food and boiled water. Daily protein intake should be between 0,6-0,8 g/kg/day, and salt intake reduced to below 2 g/day. Patients should also limit processed foods, those rich in potassium and phosphorus, and red meat. Additionally, patients must avoid non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Diclofenac. They should drink water according to their fluid status and attend regular follow-up appointments to monitor kidney function and electrolytes.

Patients experiencing symptoms such as vomiting, diarrhea, fever, poor appetite, reduced urination, edema, shortness of breath, extreme fatigue, or altered consciousness should seek hospital care for kidney function and electrolyte checks. Early detection and treatment of acute kidney injury helps preserve remaining kidney function and prevents serious complications.

Ha Thanh

* Patient's name has been changed