The kidney biopsy report suggests that you have advanced scarring of your kidney and it is not likely to reverse. If you are on dialysis, you should explore the possibility of doing dialysis at home or kidney transplantation. I am unable to make treatment recommendations without performing a complete history and physical examination.
The elevation of the serum creatinine is a normal response for use of ACE-inhibitors such as Lisinopril. By lowering the pressure inside the filters (glomeruli) of the kidney, this causes some decrease in the estimated glomerular filtration rate (eGFR) and hence a mild elevation in the serum creatinine. However, over time, this lower pressure preserves the kidney function. The fall in the serum creatinine is expected when you stop the ACE-inhibitor, but it makes for more damage to the kidney filters (glomeruli) over time. Hence, I would still suggest use of ACE-inhibitors for treatment of high blood pressure in patients with chronic kidney disease (CKD), especially if there is any protein in the urine.
I suggest that you review this with your physician.
Normal laboratory variation for the serum creatinine test is plus or minus 0.2 milligrams per deciliter (mg/dl). The variation that you are seeing the serum creatinine test is the variation we see with testing from day to day and does not necessarily suggest a change in kidney function. The normal for a urine albumin to creatinine ratio is less than 30 micrograms per milligram of creatinine. Hence, your ratio appears to be normal. I am unable to identify an evidence of kidney disease based on the information that you present.
This commonly occurs in people who have a large muscle mass, such as body builders and professional athletes. This individuals have an increased creatinine generation rate which results in an increased serum creatinine but the creatinine clearance remains normal.
Based on the information that you present, you appear to have early Stage 3 chronic kidney disease (CKD). The Losartan that you are taking should keep your blood pressure less than 130/80 and preferably less than 120/75. You should not smoke. You should eat a healthy low salt diet, such as the DASH diet. You can learn about the DASH diet at: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
You should exercise for 150 minutes per week and your cholesterol and lipids should be treated. You should try to maintain a healthy body weight and visit your doctor at least every year.
If you are doing all of these things, then you are doing what you can to slow progression of CKD.
I am unable to offer a prognosis or treatment plan without performing a complete history and physical examination.
An estimated glomerular filtration rate (eGFR) of 28 milliliters per minute per 1.73 meters squared would suggest Stage 4 chronic kidney disease (CKD). Patients with a single kidney may experience more rapid loss of kidney function over time. I suggest that you review this with your physician to see if further treatment is required. Your diabetes should be well controlled, your blood pressure should be maintained in the normal range and you should lead a healthy lifestyle with a healthy diet to maintain a healthy weight.
The best diet to prevent kidney stones is the DASH diet. I also suggest a low salt diet. You can review the DASH diet at: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
Apple cider vinegar has been advocated by some to prevent kidney stones by changing the pH of the urine. I am not aware of any controlled trials of using apple cider vinegar in stone formers. There are several types of kidney stones and some may be helped by apple cider vinegar. In clinical medicine, we more commonly use potassium citrate to treat and prevent kidney stones in certain cases. I do not know of any adverse events that might occur with the use of apple cider vinegar in patients with kidney disease.
The histamine receptor two (H2) blockers are generally thought to be safe for patients with chronic kidney disease (CKD). Famotidine is an example of an H2 blocker. Most H2 blockers are equivalent, except for cimetidine, which can cause an elevation in the serum creatinine that can be concerning. H2 blockers have been compared to proton pump inhibitors (PPI’s) and the PPI’s have been more commonly associated with CKD, especially with long term use. PPI’s such as Omeprazole and others should be used judiciously for acid reflux disease and other forms of dyspepsia and the length of use should be carefully monitored by your physician.
Monoclonal gammopathy of undetermined significance (MGUS) is a finding in the blood that, as noted in the description, is of uncertain significance and generally requires observation over time to tell if it means anything or not. The normal 24 hour urine protein is generally less than 150 or 200 milligrams per day (varies depending on the laboratory technique used). Your 24 hour urine protein is very mildly increased. I am unable to make any other specific diagnosis based on the information that you present. I suggest that you contact your physician for interpretation and recommendations. I suspect he or she will recommend monitoring this level of protein in the urine.
I am unable to make treatment recommendations without performing a complete history and physical examination. Your friend should be consulting with a nephrologist in his or her country. Treatment needs to be based on a specific diagnosis and this requires an examination. Your friend requires a specific diagnosis of his or her kidney disease in order to make treatment recommendations.
Do you have any questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member?
