Kidney Failure Misdiagnosis

Renal (kidney) disease is hard to diagnose early because it does not usually cause symptoms initially. Sometimes tests for another condition will reveal it. If so, you will need regular tests and the correct treatment to prevent the condition from getting worse.

Later stage symptoms can include:

• weight loss, reduced appetite
• swollen ankles, feet or hands – this is caused by water retention (known as oedema)
• tiredness and shortness of breath
• blood in your urine
• sleep problems – and the desire to urinate more at night
• headaches, nausea
• itchy skin
• muscle cramps
• erectile disfunction.

Many of the symptoms listed above could be mistaken for other conditions. Did your GP or hospital doctor fail to diagnose your kidney problems correctly? Were they slow to diagnose renal disease because they thought at first it might be something else? 

Chronic kidney disease – leading to kidney failure – can be caused by a range of conditions including:

• Glomerulonephritis – inflammation of the kidneys' filtering units. This can be due to a range of other conditions such as strep throat, lupus (a long-term auto-immune disease), Goodpasture's syndrome (a rare auto-immune disease), Granulomatosis with polyangiitis – previously called Wegener's disease (inflammation within the tissues), polyarteritis nodosa (a rare disease that results from inflammation of the blood vessels). 
• Interstitial nephritis – inflammation/swelling between the kidneys' tubules (very small tubes) and surrounding structures. Acute interstitial nephritis can be caused by an adverse reaction to drugs/medicines, resulting in an acute kidney injury.
• Polycystic kidney disease – clusters of cysts (sacs filled with fluid) develop in the kidneys, affecting the organs’ ability to filter waste from the blood.
• Long-term obstruction of the urinary tract – caused by an enlarged prostate, kidney stones and some cancers.
• Vesicoureteral reflux – when urine flows the wrong way, causing it to back up into your kidneys. This condition is more common among children.
• Pyelonephritis – inflammation of the kidneys. It is caused by a bacterial infection and is usually treated by antibiotics. Did your doctors fail to prescribe antibiotics promptly enough? (Doctors are becoming increasingly reluctant to prescribe antibiotics early on because they worry that infections are becoming resistant to the drugs.)  

Risk factors for a pyelonephritis bacterial infection can include sex, diabetes and use of spermicide.

Two major causes of kidney failure are type 2 diabetes and high blood pressure. These can be caused (or made worse) by poor diet and/or lack of exercise.

Alcohol can worsen kidney disease. It reduces your kidneys’ ability to filter your blood. It dries out the body, hampering your kidneys as they try to regulate the amount of water in your body. Excessive alcohol consumption can also lead to high blood pressure – a common cause of kidney disease.

When you take legal action against an NHS trust or private hospital, its lawyers may try to blame your lifestyle in a bid to block your claim or to reduce the compensation. Our experienced medical negligence solicitors are used to the NHS trying to defend the indefensible and have the expertise needed to help you win your case.

Ideally, you should have an estimated glomerular filtration rate (eGFR) reading above 90ml/min (millilitres per minute). This shows your kidneys are likely to be working normally (but other tests may be needed to be certain).

• CKD Stage 1 (G1) – a normal eGFR above 90ml/min but other tests have detected signs of kidney damage. Your urine should be tested with a reagent strip (dipstick) for signs of blood or protein. You should also have a urine specimen tested for the albumin/creatinine ratio (ACR). Your specimen must be stored in the correct container – not a specimen container used for microbiological analysis (these contain a preservative). You may need to be tested again within 14 days. You will also need blood pressure checks and blood tests. Were all these tests carried out? Were they done correctly?
   
• CKD Stage 2 (G2) – a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney damage. You should undergo the CKD 1 stage tests listed above. At CKD stages 1 and 2 you may also be at higher risk of cardiovascular problems.
   
• CKD Stage 3a (G3a) – an eGFR of 45 to 59ml/min. Your kidney problems will be getting worse. Swift assessment is needed. You should undergo a dipstick test to check your urine for blood. You should also have an ultrasound scan. Was this done?
   
• CKD Stage 3b (G3b) – an eGFR of 30 to 44ml/min. At stage 3a or 3b your kidney function is impaired. But only a few stage 3 patients suffer more serious kidney disease.
   
• CKD Stage 4 (G4) – an eGFR of 15 to 29ml/min. Serious impairment of kidney function.
   
• CKD Stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function.
   

Your eGFR is a useful test but it is not perfect. It may not be accurate if you are aged under 18, are very overweight or are very muscular. Did your doctors fail to carry out other tests to confirm whether or not you are suffering from kidney disease? Were they slow to recommend or perform these follow-up tests?

If the syndrome were caused by a tumour, radiotherapy may be an option, especially if surgery is medically impossible.

Damages claims for kidney disease can run to seven figures – particularly if:

• the patient is young
• their employment prospects are impaired
• they are likely to suffer loss of earnings
• the kidney problems are severe – resulting in one or more transplants in their lifetime
• they suffer significant reduction in their quality of life
• they suffer accompanying psychological problems as a result.

Kidney cancer – just like any other cancer – must be diagnosed and treated quickly. The sooner doctors spot it, the greater the chance of removing it before it spreads to other organs.

Warning signs include blood in your urine, pain/pressure or a lump in your side of back, high blood pressure, anaemia (low red blood cell count), tiredness and loss of appetite, fever and varicocele (rapid development of enlarged veins around the testicles – especially the right one).

Again, some of these symptoms could be mistaken for other conditions. Find out more here about delayed diagnosis or misdiagnosis of cancer.

• A urine test – to check how much albumin (a blood protein) and creatinine is in your urine and to ascertain your albumin/creatinine ratio (ACR). A healthy kidney should not let albumin pass from your urine into your blood.
• An ultrasound (sonogram), magnetic resonance imaging (MRI) or computerised tomography (CT) scan – did your doctors fail to carry out a scan? Or were they late doing so?
• A kidney biopsy – using a needle to remove a small sample of your kidney so the cells can be examined under a microscope.

• Some clinicians can fail to carry out basic blood and urine tests. They may discount the possibility of kidney disease if they think the patient is ‘too young’ or ‘too fit and healthy’ for it to be likely.
• Delay in the prescription of antibiotics. Some symptoms such as dizziness, pain in the lower back, shivering, fever and vomiting can be misdiagnosed as ‘flu. Doctors will not prescribe antibiotics for ‘flu because it is a virus. Antibiotics are for bacterial infections. But your kidney disease may have worsened by the time your doctors realise their mistake.
• Were you prescribed a strong antibiotic such as Gentamicin to treat an infection that occurred during another medical procedure? Did your doctors fail to check the toxicity levels? Was this made worse by another condition? Side effects of Gentamicin can include kidney damage.
• If you suffer from ulcerative colitis (an inflammatory bowel disease), your doctors may prescribe Mesalazine (also known as Mesalamine) to help reduce symptoms such as diarrhoea, rectal bleeding and stomach pain. If so, you should have regular kidney checks. You should be checked for possible renal toxicity every three months in the first year; every six months for the next four years and annually after that. Did your doctors fail to recommend or carry out these checks?
• Do you suffer from high pressure bladder symptoms such as a constant urge to urinate, discomfort in your pelvis or pain during sex? A high pressure bladder carries the associated risk of kidney damage. Did your doctors fail to warn you or carry out the correct tests?