Friday, July 6, 2012

Come on, kidneys.

First, the good news.  Bonnie seems to be recovering really well from her repair surgery yesterday.  Her chest x-ray looked good this morning with nice clear lungs.  She still looks like herself, i.e. not too much swelling.  Her blood pressure, which has historically been on the extremely low side, has improved to the point that it's actually *too* high.  She's on a couple steroids (hydrocortisone and dexamethasone) to increase her blood pressure, so they're going to wean those a little bit to bring it back down.

And the not so good news.  Kidneys are still not cooperating.  I had a discussion with the nephrologist today about what the heck is going on, and his feeling is that it's something called acute tubular necrosis (ATN).  I had a physiology class about 12 years ago, so I am quite the expert on the workings of kidneys. Right.  Kidneys are complicated and mysterious, but they know what they like, and what they like is good steady pulsatile blood flow.  Unfortunately for Bonnie's kidneys, they didn't have that for at least a couple weeks (due to her blood pressure being so low, and being on ECMO probably contributed as well).  The inner workings got ticked off, which caused cell damage and/or death in the tiny (and complicated and mysterious)  tubules of the kidneys, which are required to filter her blood, maintain electrolyte balance, and--my personal favorite--make pee.  According to Dr. Kidney, these dead cells should slough off and be flushed out, and things *should* be back to normal eventually.  However, he couldn't promise anything, because if the damage was very severe--and there's no way to know at this point--there could be scar tissue, which is basically nonfunctional tissue that likely won't ever recover.  Scary thought.

Here's a handy dandy diagram for you--not to help you understand the kidney, necessarily, but to illustrate how complicated it is.

So because of all of *that* crazy business, our little Bonnie will need to continue on dialysis until further notice.  There were some major issues this morning with getting her dialysis catheter to work.  Short version is that it's very finicky and only flows well when Bonnie is in one certain position.  Since babies tend to wiggle, they ended up starting her on a continuous drip of a drug called vecuronium.  We'll euphemistically call it a "neuro-muscular block," because "paralytic" sounds really terrible.  But basically, she can't move.  She's on biblical amounts of sedation to go along with this.

Ironically, her lungs aren't causing her problems at the moment, other than needing to be on a ventilator (still on the conventional vent--woohoo!).  If her kidneys could just get with it, we might be able to make some progress.  At the very least, she'd be able to get off dialysis and we wouldn't have to worry about her dialysis catheter, paralytics, etc.

I know many of you have been faithfully praying for Bonnie's kidneys (thank you!), but let me ask that you get even more specific with your prayers.  Please pray that the teeny little tubules would unclog and start flowing freely and that there won't be any scar tissue there that would prevent 100% return of her kidney function.  And of course, we would like her to pee.  Please continue to pray for her recovery from surgery and for her lungs to remain clear and open--the ventilator had to be turned up a bit because of her vecuronium (since she can't move, she can't "help" the ventilator).


  1. Will keep the prayers/good thoughts coming. Come on Bonnie!! :)

  2. Jacob was on the "vec" too when he was put on the oscillator. It was a sad time for us because he seemed so far away without moving or responding in anyway, but he was very sick in a different way during that time too. Hopefully, you won't have to worry and things will turn around quickly. The waiting game is very hard. I will pray for the kidney specifics and a special prayer for you two parents as you continue on this roller coaster of a journey.

    God bless,

  3. All the best little Bonnie and best wishes for the kidneys to fix themselves and you all to progress into removal of the vent and feeding.


  4. Come on kidney tubules, wake up, unclog, and make pee pee. You can do this Bonnie. Show them what you're made of! Hang in there momma and dado.

  5. It's the first time I have ever prayed for kidney tubules, but pray for them, I will! Thinking often of little Bonnie's fight.