Case: Chronic Renal Failure

I took note of a strange-looking little girl who entered the Resource Center while I was helping out with the dental clinics. Later we saw her in clinic. Her beautiful face looked large in comparison to her body that came just above my knee when she stood. Ellen introduced Ester as an 18-year-old. Across the table I noticed her small arms were shaped like the letter "s", bent and curved in all directions. Her legs were bowed and she could not support herself to walk. She was mentally alert and the Catholic Father that brought her told us she was top in her class. She is sponsored by a church off Tramway in Albuquerque where he will visit soon (small world!).

Esther was a stunning example of how kidney failure effects the whole body, and how much permenent damage can be prevented with proper treatment and dialysis. Her mother gave the history that she got sick in 2nd grade, "got puffy", and her bones became disfigured. Most likely, the infection in 2nd grade was followed by a glomerulonephritis, nephrotic syndrome, and now she has chronic renal failure. The kidney plays a role in making vitamin D to help absorb calcium. Without the kidneys she did not have bone growth, especially in the long bones. She also showed signs of anemia: pale conjunctiva and nail beds. Erythropoetin is a hormone made by the kidneys that signals growth of red blood cells; and, without the hormone her bone marrow does not produce enough red blood cells. In America, she would have been treated with vit D, erythropoetin and a kidney transplant. However, she has just recently come under the care of Ellen. With a consult from a nephrologist in the states, she gave Calcium and vit D supplements, Fe and folate supplements, and protein supplements. We sent her to a lab for an Ultrasound and a Voiding Cystourethrogram to determine the next steps.