Elizabeth Dravis was a medical field professional, a PhD student at UTHealth School of Public Health in Houston, an avid runner, and mother of two when she started to suffer from extreme fatigue at the beginning of the year. Dravis thought she just needed to rest after a busy holiday season until her symptoms progressively worsened and she passed out.
UTHealth Houston physicians at Memorial Hermann-Texas Medical Center wanted to rule out any cardiac issues, but initial lab work while she was in an intensive care unit (ICU) revealed something entirely different.
“My initial labs showed severe hyponatremia, critically low sodium concentration in the blood, and my albumin levels continued to get concerningly low and my body continued to excrete protein, at a high level, through my kidneys into the urine, which is not normal,” she said. Those numbers, plus her fatigue, swelling and weight gain were markers of kidney disease and potentially kidney failure.
She was ultimately diagnosed with a kidney biopsy as having minimal change disease (MCD) — a “glomerulonephritis” kidney disease in which the filtering function of the kidney becomes excessively leaky and large amounts of protein are lost in the urine.
Her team of clinicians was a collaboration of multiple disciplines and specialties, composed of physicians, fellows, residents and nurses from cardiology, rheumatology, endocrinology, critical care, and nephrology. Since multiple systems were involved, it required that they all work together to quickly determine treatment and diagnosis for Dravis.
“The admitting team brought us on board immediately, which was great, and we started the correction of the sodium a little bit,” said Mubeen Khan, MD, assistant professor of renal diseases and hypertension with McGovern Medical School at UTHealth Houston and an attending physician with Memorial Hermann-TMC. “She had this mixed picture where she looked so swollen and we wanted to get the fluid off but then her hemodynamic markers, like the heart rate and the blood pressure, were suggesting she didn’t have enough volume in her circulation.”
Dravis showed evidence of nephrotic syndrome, a kidney disorder that caused her body to lose large amounts of protein in her urine, which caused retention of fluid and severe generalized swelling. The team’s initial focus was to bring her serum sodium levels up safely in order to perform a kidney biopsy to make the definitive diagnosis.
“We requested a kidney biopsy immediately because that's the only way to get a diagnosis in this situation,” said Khan. “And fortunately, we were able to get that fairly quickly and the results showed minimal change disease, and that diagnosis explained everything we were seeing.”
MCD is rare for adults and often comes on very suddenly.
“Less than 1% of people with kidney disease will have minimal change disease, and it’s much more common in adolescents and young adults than it is in middle-aged or older adults,” said Donald A. Molony, MD, professor of internal medicine with McGovern Medical School.
After successful treatment of MCD with a corticosteroid, such as prednisone, complete remission of the MCD often occurs and there usually aren’t long-term symptoms of kidney failure. Patients can get back to their normal life. Dravis’ treatment plan called for 12 to 16 weeks of prednisone in a tapering dose, to which she has responded very well. “She has no more protein in the urine, she has normal blood pressure, and she has lost all the retained fluid,” Molony said. “She's gone into complete remission.”
Dravis began to taper off of the corticosteroid seven weeks after being discharged from the ICU. She wants to bring awareness that what happened to her could happen to anyone, and the importance of paying attention to the mundane symptoms like fatigue and going to annual doctor visits.
“In our culture, we move so fast and it’s important that we stop and listen to our bodies, and pay attention to what’s going on,” said Dravis. “This whole situation has given me a new perspective on things.”
Dravis says she is one of the lucky ones and credits her team of doctors for getting her back to health.
“Everyone on the team was phenomenal from beginning to end,” said Dravis. “My situation could have been very different had all the stars not aligned.”
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