Understanding Hypokalemic Nephropathy: Insights and Concerns
A 38-year-old woman with a BMI ranging between 16.9 and 17.2 has been battling long-term anorexia nervosa, specifically the binge/purge type, for nearly two decades. Her purging habits have persisted for at least 15 of those 20 years, occurring 6 to more than 12 times a day. Her current medications include 450mg of bupropion XL and a potassium chloride supplement of 60mEq. She seeks clarification on whether her physician and psychiatrist are correct in linking her declining estimated glomerular filtration rate (eGFR) to kidney damage caused by chronic low potassium levels. Recent observations indicate a consistent drop in her eGFR, moving from over 90-100 in 2022 to a low of 56 just a few months ago, stabilizing now around the low 70s. Despite her potassium levels hovering between 3.4-3.6, she finds this range puzzling since it does not seem drastically low enough to warrant such health concerns. Additionally, she experiences mild metabolic alkalosis and may also have pseudo-Bartter syndrome. **Question 1:** Could this minor hypokalemia lead to genuine kidney issues? If kidney damage is a concern and the purging continues, what might the prognosis look like? Currently, she does not exhibit any prominent kidney-related symptoms besides the inability to use NSAIDs due to significant water retention. If she were to stop purging, is it possible for her kidney function to improve, or is that unlikely? **Question 2:** Her current healthcare provider has capped her potassium intake at 60mEq, though she believes that a higher dose of 80mEq could be beneficial, as she has taken this amount in the past. Her PCP mentions that there is a limit to how much potassium the body can absorb from supplements. Is this claim valid, or should she advocate for a higher dosage to maintain her potassium levels above 3.5? **Question 3:** Is eGFR an appropriate indicator of kidney health at this stage, or would it be better to rely on direct measurements of kidney function rather than estimates that could fluctuate due to factors like protein intake and physical activity? How concerning is it for her to have an eGFR between 60 and 80? Having witnessed patients on dialysis, she fears her own potential path may lead there, especially considering the complications such treatment brings in terms of fluid management and physical activity. Her love for water further amplifies her worry about this situation—she's uncertain whether her health status is dire enough to enact change, yet the anxiety persists.
Answers (1)
3/21/2025, 2:10:50 AM
OpenHealth AI
Thank you for sharing your concerns. It seems you're facing significant health challenges related to your long-term anorexia nervosa and its impact on your kidney function. Let’s address your questions one by one, focusing on the most critical aspects of your condition and offering hopeful and actionable guidance.
Key Points:
- Hypokalemia and Kidney Health: Chronic low potassium levels can indeed lead to kidney issues over time.
- Potassium Supplementation: Discussing dosage changes with your healthcare provider is essential, as individual needs can vary.
- eGFR Relevance: eGFR is a useful tool to estimate kidney function, but additional testing may provide a clearer picture of your kidney health.
Detailed Explanation:
Question 1: Hypokalemia and Kidney Damage
Minor hypokalemia (potassium levels between 3.4 and 3.6) can still have adverse effects, especially considering your history of purging. Chronic low potassium can lead to conditions like metabolic alkalosis and pseudo-Bartter syndrome, both of which can have implications for kidney health. The decline in your eGFR may indicate early signs of kidney compromise, often linked to prolonged electrolyte imbalances.
Next Steps:
- Consider discontinuing purging behavior if possible. This could improve overall health and potentially stabilize or improve kidney function, as the kidneys may begin to recover once potassium levels are normalized.
- Monitor your eGFR closely with your healthcare team. If significant changes occur, discuss them promptly.
Question 2: Potassium Supplementation
Your provider's caution regarding potassium dosage reflects the body's limited ability to absorb potassium from supplements. However, your individual potassium needs may vary, especially given your history. Making changes to your supplementation should be done cautiously.
Next Steps:
- Advocate for a review of your potassium levels and symptoms with your healthcare provider. A trial of a higher dose (with regular monitoring) could be worth discussing if you feel it's necessary.
- Focus on dietary sources of potassium in addition to supplements, such as bananas, sweet potatoes, and spinach—this may help balance your levels more effectively.
Question 3: eGFR as a Kidney Health Indicator
eGFR is a useful estimate, but it can be influenced by multiple factors like hydration status, muscle mass, and protein intake. While an eGFR between 60 and 80 indicates mild reduction in kidney function, it is essential to consider the broader clinical context and your overall health.
Next Steps:
- Ask your provider about direct measurements of kidney function, such as serum creatinine or urine tests, which can provide a more precise evaluation.
- Engage in regular follow-up appointments to monitor changes in eGFR and discuss any concerns about progression toward more severe kidney issues.
Emotional Support
It's understandable to feel anxious about your health, especially after witnessing the impact of kidney disease on others. Remember, taking proactive steps towards your health—like addressing purging behaviors or advocating for your care—can enhance your outlook. If you're experiencing increased anxiety, consider reaching out to a mental health professional for support.
Final Thought: You are not alone in managing this, and taking small steps can lead to more significant changes in your health. Keep communicating openly with your healthcare team, and remember that improvement is possible with the right care and support.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.