Adapted from a Chinese medical case study
A Patient’s Journey from Near-Dialysis to Stability
Mrs. Li, a kidney disease patient from Shandong Province, China, discovered her condition when her creatinine levels were already severely elevated. After visiting multiple hospitals without improvement, her chronic kidney disease progressed to stage 5 (end-stage renal disease), and local physicians recommended dialysis.
Unwilling to accept dialysis, Mrs. Li and her family sought treatment at a renowned tertiary hospital in their province. However, doctors there also recommended dialysis.
Her blood creatinine level was 705 μmol/L (approximately 8.0 mg/dL):
Understanding the Severity
For context, women typically have lower baseline creatinine levels than men due to lower muscle mass and reduced creatinine production. A creatinine level of 700 μmol/L (8.0 mg/dL) in a woman is comparable to 900 μmol/L (10.2 mg/dL) in a man in terms of severity. This level indicates that both feet are firmly planted on the threshold of dialysis dependency.
The Challenge: Advanced, Irreversible Kidney Damage
When Mrs. Li arrived at our hospital three years ago, we faced significant challenges:
Her condition was long-standing. Although recently discovered, the underlying disease mechanisms had been developing silently for decades. The kidney cells showed severe sclerosis (hardening) and fibrosis (scarring). This wasn’t reversible inflammation, but irreversible scarring—essentially, 95% of her kidney cells were dead and beyond recovery.
Even if we could wait for kidney cell regeneration, everyone knows that kidney cells have poor regenerative capacity, requiring years for new cells to develop sufficient function. More concerning, Mrs. Li’s condition was still progressing, with the remaining 5% of kidney cells continuing to deteriorate.
The Patient’s Request
After explaining the difficulties, Mrs. Li asked:
“Can you help me avoid dialysis? I’ve been to so many places and know this can’t be cured, but they all want me on dialysis. If I can just maintain my current state without dialysis, I’ll be satisfied…”
Our Treatment Approach
This wasn’t an easy request to fulfill. I told her:
“At this stage, current laboratory tests can’t predict outcomes with complete accuracy. If you really want to avoid dialysis, let’s try a three-day trial. If we see initial improvement in three days, we’ll have confidence to continue treatment. If we don’t see even preliminary results after three days, we need to be mentally prepared for dialysis.”
Avoiding dialysis with irreversible uremia is extremely challenging. While I’ve shared many cases of kidney function recovery and educational content—with some readers commenting that I make kidney function recovery “look easy”—it’s not that simple. Those recovered patients had reversible kidney damage, but Mrs. Li’s was irreversible.
Our Two-Pronged Strategy:
- Block progression: Stop disease-causing substances from attacking her remaining kidney function
- Enhance kidney blood flow: Maximize the detoxification capacity of remaining kidney cells and potentially accelerate new cell generation
Treatment Protocol
After consultations with internal and external specialists, we implemented our hospital’s modified treatment approach using:
- Targeted external applications
- Foot baths
- Oral medications
- Fumigation therapy
- Medicinal baths
- Medium-frequency treatments
Early Results
Two days later, Mrs. Li’s urine showed disease-causing substances, indicating our first strategy was working. The presence of ammonia odor in her urine (from urea nitrogen and other nitrogenous toxins) showed our second strategy was also effective.
I couldn’t wait for the third day’s rounds—I visited her the evening of the second day to say: “We’re seeing initial results!”
She was overjoyed; it was the first time I’d seen her smile in the two and a half days since admission.
The preliminary results were reflected in follow-up laboratory tests:
Without dialysis, her blood creatinine not only didn’t increase—it decreased by 100 units!
Understanding the Improvement
It’s important to note that this 100-unit decrease didn’t mean her kidney cells had truly regenerated that much. Rather, the remaining 5% of kidney cells, with adequate blood flow, began functioning at their normal detoxification capacity.
Our kidneys evolved with a 2x reserve capacity for slow regeneration, so 5% equals about 100,000 nephrons (functional kidney units). When protected from disease-causing substances, these 100,000 nephrons can maintain bodily function “without requiring dialysis support.”
Three Years Later: Sustained Success
Three years have passed, and Mrs. Li’s blood creatinine has remained stable between 550-600 μmol/L (6.2-6.8 mg/dL). At her recent follow-up, her creatinine was 587 μmol/L (6.6 mg/dL).
She recently told me: “If I had chosen dialysis three years ago, I’d have been on dialysis for 3 years now. Fellow patients I treated with, who had similar conditions to mine, are all on dialysis now, but my condition remains very stable. Even if I need dialysis now, I’m still very lucky!”
The Science Behind Long-term Stability
During these three years, physiologically, Mrs. Li’s kidneys should have developed some new cells. Previous research shows new cells can be observed under microscopy after 1.5 years. However, the number of new cells likely isn’t substantial, and we don’t need to perform a kidney biopsy for verification—it wouldn’t change our treatment plan, no one would cover the costs, and she’d face biopsy risks.
Moreover, cellular regeneration is slow. The key to avoiding dialysis these three years has been preventing attacks on remaining nephrons and enhancing their detoxification capacity. Without addressing these critical factors, even with new cell generation, more cell death would still force dialysis dependency.
Key Takeaway
The main message from Mrs. Li’s case is this:
When uremia/kidney damage is truly irreversible, focus efforts on creating a protective umbrella for remaining living kidney cells while enhancing their detoxification capacity. Although the condition cannot be cured, kidney outcomes can still be significantly improved.
This case study demonstrates that even in advanced kidney disease, innovative approaches focusing on protecting and optimizing remaining kidney function can provide alternatives to immediate dialysis, potentially extending quality of life and treatment options for patients.
Note: This case represents one patient’s experience with a specific treatment approach. All kidney disease patients should work closely with their nephrology team to determine the most appropriate treatment plan for their individual situation.
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