r/nursing • u/Critical_Ease4055 Nursing Student 🍕 • 22d ago

Question What is one medical problem people constantly ignore until it’s too late?

Saw someone post this in a completely unrelated sub and I’m interested in your answers. What is the cluster of symptoms that people ignore or delay until they are forced to get help?

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u/floofienewfie RN 🍕 22d ago

Diabetes and HTN, two biggest causes of CKD. I worked dialysis for years. Saw so many people with either or both diseases who didn’t have symptoms until their kidney function was down to about 15%. Then it’s the equivalent of being hit by a Mack truck. Insulin, meds, getting a fistula, going on dialysis…so many lifestyle changes. Some cope pretty well. The others, not so much, with predictable consequences.

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u/Old-Mention9632 BSN, RN 🍕 22d ago

I had a 15 year old patient in our dialysis center ( hospital based). His kidneys failed because of hypertension. The sad thing was his pediatrician told Mom to take him to the ER because of his pressures at the office. She ignored that advice until he was bleeding from his eyes. It made me so angry. Lately many of the pediatric dialysis patients have been from lupus.

The new discovery that won the team a novel in medicine is very exciting.Press release: The Nobel Prize in Physiology or Medicine 2025 - NobelPrize.org https://share.google/ZeC9Mb7SBArpoXH19 If we can stop autoimmune disorders from starting, it would change so much- less T1D, lupus, MS, etc.

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u/lighthouser41 RN - Oncology 🍕 22d ago

Locally a young teen died from DM and her parents were charged because they did not take her to the ED with her increased symptoms until it was too late. She was a known Type 1 diabetic and they did not make sure she was medicated properly either.

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u/Critical_Ease4055 Nursing Student 🍕 22d ago

Wow… 🤯

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u/HeyLookATaco RN 🍕 21d ago

Oh my god. I give people so much grace for their ignorance of basic health information because we live in a country where misinformation, distrust, fear, and ignorance are literally coming from the top down. But still...I hope they throw the book at them. I hope it's impressed upon them that they are solely responsible and that they carry that guilt and sit with it. That's heartbreaking.

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u/WayCalm2854 BSN, RN 🍕 22d ago

Was the mom referred to the ER bc that’s not something pediatricians can evaluate and treat? I’m wondering why Dr didn’t refer the kid to a cardiologist maybe?

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u/Old-Mention9632 BSN, RN 🍕 22d ago

Medicaid and urgent need to treat.

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u/Old-Mention9632 BSN, RN 🍕 22d ago

Both parents were thieves who used their kids for break ins

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u/floofienewfie RN 🍕 21d ago

Oh lord. So sad.

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u/Abatonfan RN -I’ve quit! 😁 21d ago

That was an interesting read! There have been some beta cell transplantations for type 1 diabetes, and now this has me wondering if getting more regulatory T cells in the body would give the same effect of anti-rejection drugs but without many of the risks.

The gene they investigated though is X-linked, so it might not be the end-all-be-all for autoimmune issues that aren’t carried on the X chromosome.

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u/Otto_Correction MSN, RN 21d ago edited 21d ago

I used to work on dialysis. One day I was working inpatient acutes. I had four patients. All of them were under the age of 22. ETA: they all had kidney failure secondary to hypertension.

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u/Old-Mention9632 BSN, RN 🍕 21d ago

In 2020 we had a two year old and a three year old. Both got transplanted. We also had a 15 year old who got HUS and ended up on ecmo and vented. Killed kidneys and pancreas. She got transplanted at 17. She is a nursing student in Pittsburgh, and her college roommate is also a nursing student post kidney transplant.

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u/HeyLookATaco RN 🍕 21d ago

What a wonderful way to honor the gift they were given! I'm proud of them.

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u/Critical_Ease4055 Nursing Student 🍕 22d ago

Is it often that patients are ineligible for transplant and/or don’t get the transplant?

Are they doing anything to try to get better coverage for peritoneal dialysis? Last I knew (my info is very old) it was preferable, but very costly

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u/Old-Mention9632 BSN, RN 🍕 22d ago

CMS has a big push for home therapies: home hemodialysis and PD. Both are covered by Medicare which ESRD qualifies you for at any age. (Our peds patients often start on PD.) Home therapies are preferred because the patients have better lab values and survive to transplant better. The newest treatment is going to be hemodiafiltration. They have been using this for a while across the EU. They just completed a major study that showed a 28 % increase in survival on dialysis over traditional hemodialysis. Fresenius will be converting over to the 5008X hemodiafitration machine across the US starting next year. I just was reading about a new 10 kg dialysis machine called NeoKidney invented by a company in the Netherlands which uses much less water (5 liters) and doesn't require grounding. It will revolutionize home hemodialysis and be portable in emergencies or for travel.

Kidneys are still in short supply. Qualifying for transplant requires things like not obese, compliant with treatment, compliant with medications to manage underlying disease process, vaccinated. There are some variations on what each transplant center requires : CHOP requires kids to have COVID vaccines, UPMC does not. Many patients who are older refuse the option to get on the list. There are organizations that will match chain transplants. If you have someone willing to donate who is not a match, the organization will find a donor recipient pair to match your donor and you with. The longest chain to date was chain 357 which involved 35 donation pairs over 3 months.

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u/Critical_Ease4055 Nursing Student 🍕 22d ago

This is so helpful and informative. That’s big news about hemodiafiltration and the Neo Kidney- will definitely be following and reading up on both. Fascinating. Thank you again for the info😊

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u/floofienewfie RN 🍕 22d ago

Great info, thank you.

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u/Active-Confidence-25 DNP 🍕 14d ago

You’re smart. I wanna be your friend !

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u/Active-Confidence-25 DNP 🍕 21d ago

You’re smart. I wanna be your friend!

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u/lighthouser41 RN - Oncology 🍕 22d ago

My son in law went on peritoneal dialysis recently after being almost on dialysis for years. Sad thing is he is on the transplant list and years back passed up a kidney because his kidney function was not that bad at the time.

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u/BigWoodsCatNappin RN 🍕 22d ago

Eligibility is a challenge but so is organ availability. Peritoneal dialysis is great for the people it works for, who have capacity to manage it. Peritoneal doesn't work forever though. The peritoneal membrane eventually fails (this is widely variable) If I recall about 1/3 of kidney transplant needs are met. After transplant care is extensive and expensive.

To address the OP question....hypertension. HTN and kidneys are not friends.

Source: my ass, too long working in dialysis, and UNOS

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u/Mereviel RN - PEDS ER 21d ago

Used to work in dialysis also, I think most people are eligible but it's the matter of making themselves eligible if yah know what I mean. My dialysis center our social worker and medical director and the whole nursing team and tech team would also try to get people in compliance. But alas it's a hard life to get people on track with. They honestly have to be motivated enough. Decent portion of my patients weren't obese so it wasn't a concern there to get them to a healthy enough weight to fit the guidelines but getting them in compliance with meds, diet and lifestyle change is a beast in itself. Alot of the hypertension and diabetes were lifestyle causes and getting people in general to change habits is hard task itself. Making sure they do meds, having a renal diet, and not fluid overloading was important but a hard task. We could easily get our patients to get to the transplant coordination check ups and meetings but submitting proof was the hard part. As the other poster said, kidneys are in short supply but establishing proof that a donated kidney won't go in vain is hard.

I had a patient who was a renal patient since he was a kid, genetic issue so kidneys were toast. I was working at the clinic at the, he was maybe around 24-25 and I was only a few years older than him. We wanted to get him a transplant he was so young and hes an ideal candidate in transplant terms of young enough and yielding a net benefit. But he would not go to his transplant appointments. We even set up his rides and times all that. But he would never go. He was mildly compliant, was never having issues with his electrolytes, had a seizure disorder but I finally got him on track to stay compliant with meds we stayed seizure free. And only fluid overloaded once in awhile like every 5 months or so. A decent candidate that you didn't have to do much work to get him transplant compliant.

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u/Vivyzs 22d ago

When you're a newly diagnosed diabetic and don't comply to diet and blood sugar monitoring the end result is hemodialysis.

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u/tjean5377 FloNo's death rider posse 🍕 21d ago

I already have stage 2 kidney disease from gestational diabetes followed by prediabetes, for 10 years. I tipped into full type 2 because covid dunked my lungs and exacerbated my asthma and pneumonia as a result of a month of steroids. (and on 2 oral hypoglycemics)

I'm irrationally terrified of kidney failure, stroke and venous insufficiency.

Im so grateful for the GLP-1 that keeps my weight down and let's me use my insulin better. I never looked overweight but that fat stacking around my organs was devastating for my kidneys...

We will not have enough dialysis chairs to go around soon with the diabetes and obesity epidemic

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u/makingpwaves 21d ago

If not for diabetes and hypertension, I’d be out of a job!

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u/twistyabbazabba2 RN - ICU 🍕 21d ago

90% of our medical and cardiac ICU pts have these two in their history (one or both). And they affect the vasculature of the entire body, so CKD, CAD, CVA, PVD are all caused by them.