Why is there no urine output in dialysis and why do some patients get ascites?

Many but not all patients on dialysis still make some urine. They will generally make urine once or more per day. Those that still have urine output have a better time with fluid retention between dialysis treatments. Since they make urine, they do not have to have as much restriction on their fluid intake. Any urine they make, allows them to take more liquid in the diet and not gain excess fluid weight. Once urine output ceases completely, then more strict fluid restriction becomes necessary in order to avoid fluid overload between dialysis sessions.

Dialysis patients who get ascites (fluid retention into the abdomen) would likely have problems with fluid retention and likely need more dialysis than they are currently receiving.

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Posted in Ask the Doctor, Dialysis, Diet/Nutrition, Kidney-Related Health Questions

I have one kidney as the other was removed after I had renal cancer. My one kidney functions well but my question is can I have Lipo slimming treatment without harming my kidney?

I am not familiar with the use of “Lipo slimming treatment”. I do not know what that involves. Hence, I suggest that you visit with your physician about your plans.

Posted in Ask the Doctor, Kidney-Related Health Questions, Nephrectomy / One kidney

Hello: I would like to get your opinion on a 35 y.o. male whose recent CMP showed a MDRD GFR for non-African Americans of 59. Serum creatinine of 1.38. No proteins in urine. Chronic fatigue. Long-standing history of right upper quadrant and right flank distention feeling. CT abdomen negative. Small simple cysts seen on left kidney. Abdominal US negative. The lab results are new with no prior history. Hypertensive. Non-smoker. No family history of kidney disease. Repeat CMP is scheduled for eval. Question I have is even if repeat GFR is 61, for example, this is still well below the average of 100-110 for this age group. I know age-calibrated GFR is not a consensus guideline, but there are recommendations that a GFR below 75 for people under 40 should be diagnosed as CKD assuming present >3 months. Again, the concern here is the current GFR is well below average for a 35 y.o. Appreciate your thoughts. Kind Regards.

Unfortunately our Staging system suffers from being able to differentiate patients with near normal kidney function and abnormal kidney function. The serum creatinine can vary by 0.1 to 0.2 milligrams per deciliter (mg/dl) from day to day. At a very low serum creatinine, the accuracy of this measurement can result in substantial changes in the calculation for the estimated glomerular filtration rate (eGFR) as estimated by either the Modified Diet in Renal Disease (MDRD) equation or the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation. It can be difficult to estimate normal numbers when the serum creatinine is at the lower end of the detection range. This is why we designate an eGFR of greater than 60 milliliters per minute per 1.73 meters squared to be normal.

There are other clearance techniques that can be used in the normal range including the Iothalamate methodology, Cystatin C, and Inulin clearance methodology. All of these suffer from some shortcomings, complexity and advantages.

In the day to day management of kidney disease, we try to estimate progression of disease as best we can and look for a pattern of falling eGFR that would clearly suggest that kidney disease is present. The treatment is then focused on doing those things that slow progression.

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Serum Creatinine

I have stage 3A but close to stage 3B CKD. Is the dye used in an echo-cardiogram safe for me? I have heart failure and mild diabetes in which I take 1500g of Metformin a day. I’m not sure if I should refuse the dye for this test.

The contrast agent used in most echocardiograms is a saline infusion. The air bubbles in this saline are used to track the movement of blood through the heart. This is safe for anyone with kidney disease.

Posted in Ask the Doctor, Kidney-Related Health Questions

Would a person suffering with pulmonary hypertension still be eligible for a kidney transplant?

That is a difficult question to answer. Each kidney transplant center determines who will and who will not be eligible for a kidney transplant. There are no nation wide criteria that are used. Pulmonary hypertension can be caused by many things including kidney disease and significant volume overload. It would necessary for anyone with End Stage Kidney Disease and Pulmonary Hypertension to be evaluated by a Pulmonologist and a Cardiologist to see if this might be reversed with a kidney transplant. Opinions would have to be obtained from these two specialties in order to know the answer to your question.

Posted in Ask the Doctor, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Transplantation

I have a lifetime history of kidney and urinary tract “issues”; which lead to a partial nephrectomy, removing the upper pole of my left kidney about ten years ago. I lived pretty much problem free until 2014. I now have nephrocalcinosis in both my left and right kidneys. I have some simple cysts in my right kidney, which I realize are not a cause for concern. However, I also have a complex cyst/lesion (I have had it described to me as both) on my partial left kidney. It does have calcifications, wall thickening, and separations. In the last two months, my kidney/flank pain has gotten increasingly worse. Almost unbearable, at times. It also feels as though I have a uti, but the culture grew nothing. My urine did show large hemoglobin. The blood has since cleared, but all other symptoms persist. Any ideas?

The problem that you pose is a urological problem. I am a nephrologist and do not have any expertise in evaluation or treatment of complex cysts. The complex cystic change could be the result of your prior surgery, but this would best be evaluated by a urologist and specifically by the urologist who did your original surgery on your left kidney. Further testing may be needed.

For general information on kidney disease, please visit our website at: https://www.kidney.org/atoz/atozTopic_KidneyDisease

 

Posted in Ask the Doctor, Kidney-Related Health Questions, Nephrologist, Urological Issues

I had NS 3 years old and relapse again at age of 20 years (during the relapse a biopsy was performed and MCD is confirmed). I was treated with prednisolone. Now I am 26 years. In six months 3 relapses continuously occur. l take MMF and Wysolone 10 mg alternate day two week. My urine albumin is faint trace. 1. Is remission is occur? 2. What are the after effects?

The clinical course that you describe is of relapsing nephrotic syndrome (NS). Your biopsy indicates that this is caused by Minimal Change Disease (MCD). If your urine protein (albumin) is undetectable, then it would appear that you are in a clinical remission. Relapsing nephrotic syndrome can be associated with recurring infections, bone loss with possible osteoporosis, and also can cause hardening of the arteries related to abnormal cholesterol and blood lipids. Your physician will need to monitor you for relapse and also complications of the nephrotic syndrome.

Posted in Ask the Doctor, Kidney-Related Health Questions, Minimal Change Disease, Nephrotic Syndrome

I am 63, female. I have single kidney for 20 years (other fibrosed due to obstructive nephropathy). I am sufferer of chronic pyelonephritis for 5 years and DJ stent placement for 10 years. Despite all the medications, my creatinine is rising. It was 1.01 3 years ago, now it’s 1.4. My current meds are Valsartan, Amlodipine and Hydrochlorothiazide, and off and on Septra. I take half a tablet of 80mg of valsartan. I just want to NOT let my creatinine drop any further. Please give me suggestions how to avoid it. Really worried.

I recommend that you have your blood pressure checked and make sure that it is less than 130/80. You should not smoke. You should eat a healthy diet and maintain a healthy body weight. You should see your physician at least once per year and have blood and urine testing for kidney disease. If you have an infection, it should be treated promptly.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diet/Nutrition, Kidney-Related Health Questions

My 88 year old father suffers from CKD with eGFR of 30-35 which has remained steady for 4 yrs. Otherwise, besides high blood pressure, he is in good health. His kidney specialist (just retired) used 3 BP meds to keep the BP well managed. Namely Diovan, Monopril and 5 mg of Norvasc. My father was hospitalized for elective surgery and the Doctor in charge discontinued the first 2 medications while increasing the Norvasc to 10 mgs. He claimed that Calcium channel blockers are more efficient at regulating BP and BP measurements in the weeks following his release have proved him right. However I was under the impression that ARB and ACE drugs had their use in CKD irrespective of BP use. Please give us your input because as mentioned our kidney specialist is not available. If I can get the Doctor to reintroduce one med, would either the ARB or ACE class of drug be preferable?

It is true that either an ACE-inhibitor or an ARB agent is used to treat and slow the progress of chronic kidney disease (CKD). Currently, the use of both an ACE-inhibitor and an ARB agent is not a recommended treatment for CKD. The Monopril that you mention is an ACE-inhibitor and Diovan is an ARB agent. I am not able to recommend medical treatment without performing a complete history and physical examination. I recommend that you review this treatment with his primary care physician (PCP).

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions

Hi. My name is Razak. I am 18 yrs old. I just felt pain in my both lower side of my ribs when I went to bed. After 3-4 mins, it disappeared. I think that pain was from my kidneys. The pain was in lower back side of the ribs. I took Fluconazole 3 hours before the pain and I drank milk after that. Is there something serious?? Please tell me. Now it’s fine by the way. If there is something serious, please tell me. It happened very first time to me. This thing never happened before but now I am feeling completely fine. Please tell me if there is something serious.

I do not recognize any kidney disease based on the information that you provide. If the pain recurs, then I would contact your primary care physician for an examination.

Posted in Ask the Doctor, Kidney-Related Health Questions