My mom (62 F) underwent a successful double lung transplant back in 2020 to treat her emphysema and COPD. While the surgery went well, she has been on a heavy regimen of medications, including tacrolimus. From what I’ve gathered, that specific anti-rejection drug has done significant damage to her kidneys.
Beyond that, she has a lifelong history of disordered eating. We also just found out she’s been secretly addicted to T3s for pain that is likely psychosomatic; she is incredibly deceptive about her substance use. Even worse, we recently discovered she started smoking again after the transplant, which leaves me feeling a lot of anger toward her.
She was recently admitted to the hospital because she was acting confused and disoriented. Today, the medical staff informed us her eGFR has dropped to 8.
Just a few months back, our family doctor told me she was still years away from requiring a kidney transplant. However, looking at an eGFR of 8, doesn’t that mean she needs one immediately?
I am 34 years old and I’m just now processing the deep trauma caused by her lifelong health battles. Can anyone give me an idea of what her future looks like? I am desperate for any information. I’m having a very hard time right now.
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It is possible she has chronic kidney disease, which is likely what the GP was referring to, but she might be suffering from an acute kidney injury on top of that, causing a sudden drop in function. This is a frequent occurrence. The doctors will investigate the trigger to see if the recent damage can be turned around. While chronic conditions generally don’t improve, acute injuries—sometimes caused by simple things like dehydration—can get better. This sounds like a very difficult situation. I wish you the best.
I have concerns that she might not be a candidate for a kidney transplant if she is currently smoking and misusing prescription drugs. While chronic kidney disease can take a very long time to reach the stage of failure, acute injuries triggered by meds or dehydration can cause a rapid decline. Sometimes the kidneys bounce back from these acute events, and sometimes they don’t, leading to a need for dialysis or a transplant. Since she is hospitalized, they will be closely tracking her blood work and urine to try and restore function. If there is no improvement, you’ll have to consider dialysis. I highly suggest requesting a palliative care consultation. They can help discuss her long-term prognosis and help your family align on health goals and treatment paths.
Many people with long-term lung transplants eventually face kidney issues because of the intense immunosuppressants required to keep the lungs healthy. It is unclear if your mother is experiencing a sudden acute event or just the natural progression of chronic damage. On the bright side, dialysis is a very effective treatment, which is why kidney transplants aren’t handled as surgical emergencies. There are several types of dialysis available, so I recommend researching which version would work best for her and your family’s situation. Sending my best wishes to your mother and your family.
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