Serum Creatinine level of 99; AKI warning stage 2, GP failed to follow up or inform me

[Bibliophile23]

Hello

In November, I was persuaded to attend A&E as I had some swelling in my legs, breathlessness and a cough, along with some unexplained bruising. I also felt unwell in general.

I had bloods taken in A&E and then waited for 7 hours, I really needed to go home at this point to look after my DC, and no one else was available.

I also thought I was probably neurotic and wasting their time being there.

I spoke to the staff of reception before I left the department who reassured me that if I went home and the blood results were abnormal, they would be picked up by my GP the same/following day who would contact me if needed.

I didn’t hear from my GP (or A&E) so presumed that everything must be fine.

Fast forward to last week and I contacted my surgery and requested a copy of my current medication list. The receptionist has emailed me my entire medical records for the last few years; including my blood test results from November.
The blood results show that my serum creatinine levels were too high and showed ‘AKI warning stage 2’. I needed to have my urine testing for blood and protein, amongst other things (e.g. consider sepsis, obstruction).

No action was taken and I wasn’t informed of the results.

I don’t know what I should do, can I ring my GP to follow up after this long? Should I?

The thing is I have been experiencing continuing symptoms, which I haven’t discussed with my GP because I wasn’t sure what to ask them for seeing as my bloods had already been done (I’m autistic which doesn’t help with communicating things).

I can’t be certain but these symptoms could very well be kidney related (never considered it before).

I’ve attached the results. I might be misinterpreting the results but I don’t think so.

Unfortunately this is the issue with sept discharging from A&E once investigations have been started. Not trying to have a go but will try and explain how these results probably got lost in the void.

• The advice given by A&E about GP following up the bloods was well intended but unlikely to have happened.
• Legally, the responsibility for acting on results lay with those who requested it- in this case A&E.
• When you discharge yourself from A&E you are taken off the 'patient list' and so it's very easy for them to forget to look at your results- if you haven't had a clinician allocated yet then no one will be aware that you have bloods to check.
• The GP practice may well have been sent the results but will likely have assumed that these were acted on by A&E, as they would have been if you hadn't self discharged and had waited for a clinician review
• In an ideal world there would be things in place to catch these missed results, but with things at breaking point clinicians are probably only able to look at the issues directly in front of them.

Anyway, please talk with your GP relatively urgently about getting bloods repeated to see how things are now.

Ok, firstly i would try not to worry

AKI is Acute Kidney Injury and the cause is normally dehydration , and is ‘normally’ temporary

Its very normal for blood tests to be abit up and down when poorly

All the other blood results loom reassuring

This week, contact the gp surgery, tell them your symptoms you have been having , discuss your worries about the blood results and ask them if they can do some more bloods especially kidney function EGFR and Creatine as well as a urine sample

What are your symptoms? If you want to share ofcourse

So... in this scenario, if you had stayed in the department rather than leaving early, the doctors would have noted the result (which is actually very borderline despite the computer seeming to warn otherwise) and they would have A) asked you to book in with your GP for a repeat test and B) included information in the discharge letter about the need to repeat a test. The fact that you decided to leave before your results were issued meant that you effectively removed yourself from the system. Your discharge letter will have been automated when you left and will not have been able to include your results. A consultant will automatically get sent the results of every patient who has been seen in the preceding 24 hours without any context of why they've been seen. They will act on any bloods that are wildly abnormal, but don't have time to write letters to GPs about every single borderline abnormal result. It's always best to stay in the ED until blood results are back. Obviously if you have a serious emergency at home and you need to leave, that's different, but otherwise staying for your results is safest. They probably should have worded it better that you'd only be contacted if the result was significantly abnormal.

geogrump I do understand, and it’s my fault for leaving a&e and not following up with my GP myself. Thank you for replying.

I am a bit concerned in case it is medication induced and I’ve carried on taking it.

It’s really worried me, to the point that I considered contacting out of hours this weekend but thought that may be a bit dramatic.

I do still have vague symptoms now (not exactly the same ones) for example: hand spasms, recurrent yeast infections, skin thickening and texture change on my face plus the back of my hands, intermittent diarrhoea, and other minor things that aren’t worth listing.
So, not exactly things you’d be rushing of to see the GP about but they’re still there I suppose.

I had been getting mildly concerned about swelling around my stomach area over the past couple of weeks, which could just be fat gain, but it’s been very sudden and looks out of proportion.

I’d also been concerned about a mild yellow tone to my skin, but I talked myself out of that being a problem because it’s only noticeable where my skin creases and on the soles of my feet (I have white sclera).

If I contact the GP will they let me do a urine test? Or would they have to ask for new bloods to be done first? I really hope a urine test to be done quickly to calm some anxiety down.

HateEatingInTheDark that sounds reassuring! Thank you.

I will contact the GP and hopefully will get the tests re-done. I really will feel stupid explaining my symptoms though as they’re all just so vague and unrelated to each other, plus I can’t seem to stop myself from downplaying things when sat in front of a medical professional for whatever reason (I think it’s so I don’t feel stupid if I’m wrong or worried about nothing).

Maybe you could write them all down and reads them out or give the gp the piece of paper if easier

Maryandherlamb The result being borderline sounds very reassuring.
There’s probably no reason for me to suspect I’m at risk of sudden collapse then, I have probably panicked unnecessarily after seeing the red writing in results!

It is borderline but think with your other symptoms that its worth asking for some more tests / urine test

HateEatingInTheDark I will ask them to repeat the kidney related tests. I don’t know whether it’s worth asking for anything else though. I think it was a metabolic screen they did at a&e and that was the only abnormality.

I did have some bloods taken around a year ago. I had to stay in hospital after developing mouth ulcers and a rash (something called Steven Johnson syndrome was suspected due to being on a high risk medication, but I didn’t have it). Those bloods all came back normal, but I don’t what bloods would have been taken in that situation.

If you tell your doctor all your symptoms they will decide what you need

You can probably get blood tests done by practice nurse if it gives you an earlier appointment. My levels were up a bit and I was called back for follow up tests after 3 months.

I’ve got an appointment at 4.45pm. Will put my mind at rest at least.

Hope all goes well OP. You are doing the right thing getting checked.

Please go to the GP and get his/her advice, stop trying to figure this out for yourself.

Oh ok, you have an appointment. As other posters have said, ensure to mention all the symptoms

I only saw these blood results on Friday afternoon. It's probably nothing, but best to make sure.

My GP diagnosed me with Lymes disease last summer after a strange rash (I’m not convinced it actually was lymes) he said that I didn’t need to have the blood test to confirm as the rash was conclusive.
I wonder if it’s all related to that?

I know there’s no point guessing. But it’s so hard not to! I’m obsessive by nature.

Interested to hear what gp says about this. I got some blood results on Saturday that said aki warning stage 1 but gp hasn't said any more about it. I've called for clarification this morning but not heard back yet! Hope all is well

Makes you realise how we need to check everything atm and can't rely on doctors etc.

This.

Did you read geogrump post?

Please, use some common sense.

How did the appointment go OP?

I had AKI stage 1 back in September, with low sodium levels. They decided it was my antidepressants causing it.

How do they diagnose acute kidney injury please? I am on lots of meds including antidepressants.