Ms. Nhai underwent an examination at a hospital in Ha Noi, where she was unexpectedly diagnosed with end-stage kidney failure. Her glomerular filtration rate was just over 8 ml/minute/1.73m2. She had no clear symptoms of kidney failure, only occasional fatigue and poor appetite. No one in her family had a history of this condition.

Ms. Nhai traveled from Hai Phong to Tam Anh General Clinic District 7, Ho Chi Minh City for treatment. Dr. Do Thi Hang, Specialist Level I, Head of the Nephrology - Dialysis Unit, diagnosed increased toxins, severely decreased glomerular filtration rate, anemia, low hemoglobin (Hb), and proteinuria. Ultrasound showed poor renal cortical-medullary structure. Despite this, the patient maintained a good appetite, her blood potassium levels were normal, and she had not yet developed many complications.

The doctor noted that the patient still had good urine output, approximately 1,500 ml daily, and had not developed severe complications from end-stage kidney disease. She maintained a good appetite and overall health, indicating that her kidneys had not completely lost function. The patient had few underlying health conditions, suggesting a better prognosis for conservative kidney function treatment.

The doctor developed a treatment plan to help Ms. Nhai maximally restore her glomerular filtration rate without early dialysis. This involved adjusting water, electrolyte, acid-base, and hemodynamic imbalances, monitoring daily fluid intake and output, and managing the patient's diet and medication. Since Ms. Nhai was taking antibiotics for an ear infection, the doctor adjusted the dosage of antibiotics, anti-inflammatories, and blood pressure medication to prevent further kidney damage. She needed adequate fluid intake, either orally or intravenously, while avoiding pulmonary edema and increased cardiac burden.

Ms. Nhai continues kidney function treatment, avoiding long-term dialysis. Photo: Tam Anh General Clinic District 7

The patient's protein intake was reduced to 0,6-0,8 g/kg body weight/day. She received protein supplementation in the form of amino acids (AA) and ketoacids to prevent malnutrition without increasing the burden on her kidneys. Sodium, potassium, and phosphorus intake were restricted, and blood sugar was controlled.

Each month, Ms. Nhai traveled to Ho Chi Minh City for treatment according to the doctor's regimen, adhering to medication instructions, dietary guidelines, and nutritional plans. Initially, if medical treatment was unsuccessful, the doctor planned to perform an AVF fistula surgery for long-term dialysis. However, after three months, the patient's kidney function significantly recovered, with her glomerular filtration rate increasing to 21.45 ml/minute/1.73m2 of skin. She temporarily avoided dialysis. She needs to attend follow-up appointments as scheduled for regular kidney function monitoring, follow fluid intake instructions, and effectively manage her blood pressure and underlying conditions.

Currently, the Nephrology - Dialysis Department at Tam Anh General Hospital Ho Chi Minh City and Tam Anh General Clinic District 7 are providing conservative kidney function treatment for many patients with end-stage kidney failure. Some patients who previously underwent dialysis have seen significant improvement in kidney function thanks to the appropriate treatment regimen, thus not requiring further dialysis.

The Ministry of Health estimates that Vietnam has over 8.7 million people with chronic kidney disease, accounting for 12.8% of adults, with approximately 8,000 new cases each year. Many individuals are unaware of their condition until it reaches an advanced stage. Dr. Hang stated that if the cause stems from acute kidney injury, the kidneys might recover after addressing the underlying causes like dehydration, infection, or urinary tract obstruction. For chronic kidney failure, kidneys cannot fully recover, but remaining function can be preserved. Good control of blood sugar, blood pressure, and a suitable diet can slow disease progression, delaying dialysis for many years.

Ha Thanh