Ask the Doctor

If a person has CKD, should they avoid ALL dyes when receiving tests, such as, MRI’s, CT’s, PET’s, and tests using radioactive dye?

The National Kidney Foundation — Fri, 27 Jan 2012 15:26:12 +0000

Contrast used for computerized tomography (CT) scans and contrast used for magnetic resonance imaging (MRI) may cause complications for patients with chronic kidney disease. Nuclear scans and positron emission tomography (PET) scans do not cause problems for patients with chronic kidney disease (CKD).

I have only my left kidney and it has been hurting for two days. Should I see my doctor?

The National Kidney Foundation — Fri, 27 Jan 2012 15:25:22 +0000

Kidneys do not commonly cause pain unless there is an infection or a blockage in the kidney or urinary system. If you have persistent pain, you should see your doctor to have a specific diagnosis and treatment plan.

My mother, 62, a diabetic for the past 10 years, 6 years on insulin, suffered hypoglycemia three weeks back. Her creatinine started to spike with potassium, going up to 5.1 and potassium to 6.5. After two days of fluids in a hospital, her creatinine levels dropped to 4.8 and potassium under normal range 4.5. Doctors were advising dialysis, three times a week, life long, but after talking to the head of nephrology, they said she is responding well to medicines and tests, but sugar levels are fluctuating 100-300. However, when I talked to other doctors at another center, they said they don’t advise dialysis for patients with constant creatinine under 5, and suggest decreasing it by food control, diet and medication. Is dialysis needed at all? If creatinine keeps on dropping slowly, even then is dialysis required? If dialysis is needed, then it will be periodical, let’s say monthly or twice a month, once in two months OR thrice weekly/lifelong? Is kidney replacement an option if she has diabetes?

The National Kidney Foundation — Fri, 27 Jan 2012 15:23:42 +0000

I am not able to provide medical advice without performing a complete history and physical examination. As I approach problems like this, I encourage families to carefully listen carefully to their parents and older individuals for their preferences. The decision to undertake or forego dialysis therapy is a very complex one and needs to be carefully discussed with her doctors and her primary care physician. These decisions are never easy, but if you listen carefully, your mother will give you the answer. Dialysis is not started because of a specific number for the serum creatinine or because of a specific symptom. It is recommended by physicians who are familiar with dialysis therapy and agreed to by patients who believe the risks and complications of dialysis are worth the cost, discomfort and inconvenience that may arise from dialysis therapy. Patients with diabetes may do just fine with dialysis, but do not survive as long on dialysis as non-diabetics.

I am African American with CKD and high blood pressure for the past seven years. My creatinine has jumped from 2.4 to 7 and my doctor wants to put me on dialysis. I’m 37 yrs old. Is this normal in blacks?

The National Kidney Foundation — Fri, 27 Jan 2012 15:17:32 +0000

Black individuals have 3 to 5 times the risk of developing kidney failure as compared to white patients. Chronic kidney disease (CKD) is much more common in black patients as is high blood pressure and diabetes. Black patients are more likely to suffer kidney damage from high blood pressure and diabetes than any other race. You should follow closely with your kidney doctor.

My son in law was diagnosed with MPGN Type II. He is on prednisone, blood pressure medicine and now insulin. I am beginning to see the long-term problems with this disease, but am wondering how this might affect their chances of having a baby. My daughter is quite healthy (29) and my son in law is 31.

The National Kidney Foundation — Fri, 27 Jan 2012 15:15:36 +0000

Membranoproliferative glomerulonephritis (MPGN) Type II is also known as Dense Deposit Disease. It is a relatively uncommon cause of kidney disease. Unfortunately, it does not respond to treatment very well. Although treatment is usually attempted, it is uncommonly successful. It usually causes protein in the urine and blood in the urine. Kidney failure may progress very slowly. Chronic kidney disease does not commonly affect male fertility. Men on dialysis have fathered children, although they may have some decrease in sperm count and also may suffer from loss of libido because of chronic illness. Most patients with this illness eventually progress to kidney failure and require dialysis and transplantation.

About 10 days ago, I had my left adrenal gland removed. Will that effect my left kidney now?

The National Kidney Foundation — Thu, 26 Jan 2012 20:32:47 +0000

Removal of the left adrenal gland should have no effect on the left kidney function. It is important that you have a normally functioning adrenal gland on the right so that you do not suffer from hypoadrenalism (known as Addison’s disease).

I am a 56 year old white female. I just had some blood tests taken and it shows my GFR to be >60. Does that mean I have kidney disease?

The National Kidney Foundation — Thu, 26 Jan 2012 20:31:58 +0000

This is a normal estimated glomerular filtration rate (eGFR).

I have been on dialysis since September. I am 77 years old. Am I too old for a kidney transplant? I have type 2 diabetes and a pacemaker. I was told that I would not tolerate the meds after the transplant. What do you think?

The National Kidney Foundation — Thu, 26 Jan 2012 20:31:07 +0000

The decision to place you on the transplant list is one that is made by a transplant team. Regardless of your age, you are entitled to request a transplant evaluation. If you have significant heart disease, that may be reason why you would not be a candidate for the transplant list, but you are still entitled to an evaluation.

I have a PTH level that is currently above 1000 and has over the past 3 months only gone up from about 700. I currently take calcitrol everyday. My calcium level is low (within range). Is there anything else to be done? I am a CKD patient on peritoneal dialysis.

The National Kidney Foundation — Thu, 26 Jan 2012 20:29:51 +0000

This is known as secondary hyperparathyroidism and may be treated with medication but sometimes is treated with surgical removal of the parathyroid glands from the neck. I am not able to give medical advice without a complete history and physical examination. This is a discussion you should have with your dietitian and your nephrologist. Parathroid hormones levels above 1000 picograms per milliliter represent severe secondary hyperparathyroidism. If this level cannot be decreased into the target range, surgery is commonly required.

My brother is on dialysis and been testing high for phosphorus. He’s cut out eating cheese and drinking milk. The only thing he eats a lot of is cans of corn and dried cranberries. He does take binders but he only takes them at meal times. How can he get his levels down?

The National Kidney Foundation — Thu, 26 Jan 2012 20:28:28 +0000

He should review this with the dietitian assigned to him at the dialysis unit. The dietitian is most qualified to review this information and make recommendations about dietary modifications. He may need to review the other medication that he takes and also may need to discuss the status of his parathyroid glands with his nephrologist. Dialysis patients may suffer from secondary hyperparathyroidism which makes control of phosphorus very difficult. Secondary hyperparathyroidism may be treated with medication, but sometimes it is treated with surgery.