It took quite a while for Babygirl's new kidney to arrive here from wherever it came from. That means there was a long "cold time." From the time an organ is harvested until it is attached to its new owner, that organ is kept on ice to slow cell death and improve viability. The longer the cold time, the more cell death/organ damage. The longer the cold time, the more likely it is that the organ won't function as well (or at all) when transplanted.
How do you see if the new kidney is doing what it is supposed to do?
1) Measure the urine output. For someone Babygirl's size, normal output with 2 liters/day input is 30-90 ml/hour (about 1-3 oz/hour).
2) Measure the standard renal function tests (BUN/Creatinine/GFR).
3) Measure secondary labs of things affected by kidney function: Potassium in the short term, hemoglobin in the long term.
So, Babygirl.
1) Last night her urine output was about 15 ml/hour. This has improved but not entirely normalized with overhydration, which leaves her feeling really puffy and bloated. She has a catheter in, and the urine is bloody (which is not surprising but last time I recall a large quantity of clear yellow urine). To be safe, they just flushed the Foley catheter, which removed some small clots, and allowed a moderate amount of trapped urine out. This did make the output look somewhat better.
2) Standard renal function tests look, well, terrible. Since the kidney isn't putting out much urine, this is not unexpected, and will hopefully improve.
3) Hemogobin just doesn't count here. She was anemic getting here, as always, and lost blood during the surgery, and is still bleeding into her urine, so no matter what the new kidney has to say about it, she's going to stay anemic. Anemic enough that she is getting a transfusion later, once there is an IV available that isn't already occupied with giving her some other life-saving medication.
Potassium, however? THAT went up from normal (3.5-5) to 7.5 after Citygirl and I left last night. So the emergency dialysis team got called in for the second time since we got here to dialyze her in the night. She did not get much rest. Subsequent potassium levels have hovered above 5, but in the high-but-safe range. 7.5, by contrast, is in the cardiac arrythmia range. She is on a potassium restricted diet (apple juice ok, OJ no way).
I've been told it can take a week to "wake up" a stressed transplanted kidney. Because of this, she may require dialysis off and on during that time.
Unrelated specifically to kidney surgery (in other words, complications that can occur with ANY abdominal surgery), she has a collection of fluid in the abdomen. It wasn't there postoperatively yesterday when she had her first ultrasound, but it was there this morning. CT scan confirms the fluid, but (somehow?) made it clear that she does not need a drain placed, or surgical evacuation. Repeat ultrasound in the AM.
There is a team of 8 people in here right now prioritizing her need for anti-rejection medication against her need for blood. It is a complicated rock/paper/scissors game, trying to avoid giving 2 highly allergenic things at once, making sure that if she has a reaction to something, we know which-the-heck thing caused it.
This is more-or-less run of the mill postoperative....stuff.
That doesn't mean I am enjoying the moment.
DeeDee
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