Dear Shirley,
Acute Kidney Injury is likely a concern.
From this study; Int J Endocrinol Metab. 2014 Jul; 12(3): e16713.
"Predictors of Acute Kidney Injury in Geriatric Patients Undergoing Total Knee Replacement Surgery"
Take home conclusion: In Total Knee Replacement Surgery, when examined separately, both DM and preoperative ACEI/ARB use increased the risk of AKI; however these factors were correlated and were not independent predictors of significantly increased risk. Patients with DM have higher tendency to develop AKI and hence, preoperative renal risk stratification should be done in all patients with DM.
Best regards,
Wisit
Thank You Wisit for your reply. No dx of DM or kidney insufficiency preoperatively; hovever, ACEIARB was taken prior to TKR. He had a nonremarkable pre-op screening.
I have just been told my father will die and will be recieving pallative care/hospice. Kidney problem, a little HTN and he was taken an ACE, other than that no other problems. Went in for elective knee replacement, abdominal distention acured, pneumonia, and AKI developed. Vanco and Zosyn started. This was around post-op day 5 . Then had laproscopy. No obstruction noted but due to several areas of bowel were thin and unfortunately torn during the procedure. Those areas were sutured. According to the surgeon the bowel was washed out. Following this no obstruction or ileus was noted;however, Miralax, Lactulose and stool softner was given. Dialysis was started.It seemed to help. He recieved dialysis 3x/week for around 4 weeks. Kidney profile improved some, but then he started having massive diarrhea; during that time Creatnine and Bun again became elevated once again. By this time Dialysis treatment was placed on hold. Abdomen became distended once again and diarrhea continued. Then the dx of C-diff came. Flagyl added to antibiotics. CAT scan done of abdomen. It showed enlarged and thick large intestines. I failed to mention that Albumin was started due to third spacing of fluids.
My family met with doctors today and was told we had two choices, another bowel surgery where the intestines would be removed and he would need to have a permanet ileostomy placed, which increases the risk for more dehydration,as well as, the risk of the surgery itself because of his current health status.
Then the dreadful news and suggestion of hospice/palliative care. I don't understand how does a person without a hx of DM or kidney disease, and healthy, walk into the hospital for a knee replacement and end up being discharged from the hospital to die. I am totally floored.
The cause of AKI is probably due to pneumonia causing sepsis & hypovolemia due bowel distension & diarrhea . Sepsis is an important cause of post operative AKI . I would request you to continue dialysis . Management of Pneumonia & conservative management of bowel disorder should help him recover from AKI . Please do not use ACEI for managing hypertension & keep him well hydrated . Any other procedure can be done after he recovers from AKI .
It also depends on how bad your father's kidneys were to begin with before the TKR operation. I work with a lot of patients who walk the fence of developing kidney failure or maintain a low and stable functioning kidney. Your father's kidneys could have been bad enough such that the stress of a TKR procedure was enough to push them over the edge into failure.
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