My mother is 84 years old. She had dialysis for almost 4 years and had her last treatment on 12/22/17. She decided that she no longer wanted to have treatment. Her decision totally. The dialysis treatment was brutal and literally killing her. My question – she entered into home hospice the first of January 2018. As of today, she has not had dialysis for 80 days. She is also still producing urine – while not like she was before. She has always urinated more than anyone I ever known that was on dialysis. While I know she was probably not filtering the toxins out, she was still urinating a lot. She is confused – which is normal, very little intake of any kind. I know my mother is a strong woman. We are just so puzzled by the length of time since her last treatment. By no means do we want her to die, but from what we were told/reading, we thought she would go quick – like usual ESRD patients who stop dialysis. Thank you.

The length of time that one can go without dialysis is variable and dependent on the underlying state of health of the individual. For individuals who have been on dialysis for more than 6 months, such as your mother, the average time of survival after stopping dialysis is usually about 10 to 14 days. Some individuals, such as your mother, live longer and some live a shorter time. As long as your mother is not suffering, she should live as long as she can and as well as she can.

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney-Related Health Questions

Hi Doctor, I had a creatinine serum test done two years ago and the result was 0.6 and I just had one done last month and the result was 0.9. All other tests were good. Please, I would like to know what caused the increase, even though am still within the normal range? I am a 41 yr black female. Thank you.

The most likely explanation is a difference in the laboratory testing from day to day.  I am unable provide a specific diagnosis without knowing your complete history and performing a physical examination. The measurement of the serum creatinine by the laboratory can vary from day to day. I suggest you discuss your concern with your physician.

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

I have lab results of creatinine at 2.21. The level was 1.6 five months ago. I have had my bladder and prostate removed. What stage am I at?

I suggest that you go to our web site and use the estimating equation for the glomerular filtration rate (eGFR). This will then allow you to estimate your Stage of chronic kidney disease (CKD).

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

My 88 year old grandfather has stage 3b CKD but is otherwise in good health besides suffering from high blood pressure. He is presently taking Diovan/HTC 80/12.5 mg, Monopril 5 mgs and finally Amlodipine 5mgs. His personal physician wants to increase his BP meds because he found it too high on his last checkup. Given the fact my grandfather takes Diuretics, ARB’s, ACE’s and CCB’s each with its own mechanism of action. What category would be the best choice to increase in order to safeguard his kidney? I have heard that Ramipril (=Monopril?) is the best choice. Also his kidney specialist has prescribed Sodium Bicarbonate 500 mgs x 3. Could the salt content in these pills be contributing to the increase in BP? Thank you for all your great work!

Diovan (Valsartan) is an angiotensin receptor blocker (ARB).  Monopril (Fosinopril) is an angiotensin converting enzyme inhibitor (ACE-I).  I do not recommend the use of both an ARB agent and an ACE-I agent for blood pressure control in patients with chronic kidney disease (CKD).  I suggest that you allow the nephrologist (kidney specialist) to adjust the blood pressure medications in your grandfather.  I am not able to recommend medical treatment without performing a complete history and physical examination.

Posted in Ask the Doctor, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Medication and Kidney Disease, Nephrologist

My mother was diagnosed with CKD stage 3B. It is now stage 4. Last test showed her kidneys are only functioning at 23% their normal capacity. I have type O negative blood. If I turn out to be a perfect match, can I donate my kidney anonymously to my mother by contacting her doctor? My sister is power of attorney and claims the doctor said she’s too old to get on a donors list and because her disease is related to high blood pressure, she is automatically disqualified to be on the list. I find this hard to believe. She’s 68 years old. I’ve asked my mum if she’d take one of my kidneys and she says no because I might need it later. If it will save her life, I would do anything. So I’d like to know if a person can anonymously donate a kidney to a family member without the family member having to know where it came from. Thank you. The time before last, her kidney functions where at 28%. Now they’re 23%, so she’s losing them fast and I’d like an answer as soon as possible. Thank you.

I order for you to donate a kidney, your mother must first be evaluated to make sure she is eligible for listing on the transplant list.  In order to be evaluated, her estimated glomerular filtration rate (eGFR) must be less than 20 milliliters per minute per 1.73 meters squared and it must be less than 20 repeatedly.  Most transplant centers will require the eGFR to be less than 20 for greater than 3 months before they will consider evaluation for listing on the transplant list.

Once your mother gets listed on the transplant list, then you can approach the transplant center to see if they would consider you as a donor.  I am not sure how anonymous this can be.  It would be difficult for you to be a donor and keep this from your family.  With your sister being power of attorney, she would have to be involved in any decision about accepting a kidney for a transplant.  If your mother does not want to be evaluated for kidney transplant and be listed on the transplant list if medically acceptable, then there is no way for you to be evaluated as a donor.

Posted in Ask the Doctor, Donation, GFR, Kidney-Related Health Questions, Transplantation

My father is above 60 years old. Recently he was facing some problem with urine. So he had a test and it says: urine microalbumin- 360mg/L, urine creatinine-1.03 gm/L, Micro Albumin Creatinine ratio 350mg/gm. What does it mean? Is it a kind of kidney damage?

Albumin in the urine (albuminuria) means that some damage has occurred to the kidney as a result of diabetes, high blood pressure or hardening of the arteries (atherosclerosis). Normal albuminuria is less than 30 milligrams per gram of creatinine. Hence, your father has evidence of kidney damage that would be consistent with chronic kidney disease (CKD) if it was present for at least 3 months. I am unable to provide any other specific diagnosis based on the information that you provide.

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Serum Creatinine

I have Diabetes that is not well controlled at the moment. (Diabetes Doc and I are working on additional treatment options). Sugars before were controlled. I had some blood work done recently which one of the tests showed a BUN/CREATNINE ratio of 27. Should this be investigated further or should I be concerned? I have lots of fluid in my right leg that is being investigated further. Thanks.

The Blood Urea Nitrogen (BUN) to creatinine ratio is a calculated number that is sometimes used to suggest that dehydration may be present.  There are many causes of an abnormal ratio but this usually does not need further investigation when the two underlying values (BUN & Creatinine) are normal.

Posted in Ask the Doctor, Kidney-Related Health Questions

I changed BP meds from Benicar to Valsartan HCTZ and just about the same time my GFR dropped to 40 and creatinine went up to 168. Do you think there is any connection here? If so can this be corrected or is the damage to the kidneys irreversible? Thanks.

The hydrochlorthiazide (HCTZ) is a diuretic and can lead to a slight decline in the estimated glomerular filtration rate (eGFR) and a slight increase in the serum creatinine. Benicar (Olmesartan) and Valsartan (Diovan) are very similar drugs and act in exactly the same way. Hence, the addition of HCTZ to the Valsartan is likely responsible for the changes that you observed. The most important thing to do is to control your blood pressure to less than 130/80. If your blood pressure is under better control, then this is better for your kidney function in the long run. If your physician made this change to improve your blood pressure control, then this is the appropriate medical treatment for your overall kidney function and kidney disease.

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

I recently had my yearly physical and received a shock in my blood work. About myself–I’m a 61 year old female, 5’6″, 170 lbs. No previous history (or so I thought) of renal disease. My serum creatinine was 105 umol/L and potassium was 5.6mmol/L. My eGFR is 50. My blood pressure at my physical was 130/86. I’m a former RN and I’ve been upset by all this. I phoned the doctors office and was told that my eGFR has “always been low’ and “that’s just your normal.” Is an eGFR of 50 ever normal? I pressed them, but the Doctor didn’t order any more blood work and no urinalysis. The Doctor had said that my blood pressure is a bit high but that I need to lose weight. Last year my serum Creatinine was 101umol/L, but at least my potassium was normal then. So now I don’t know what to do. I’ve put myself on a low protein, low K diet, and increased my exercise. but I don’t know if I should worry or not.

An estimated glomerular filtration rate (eGFR) of 50 milliliters per minute per 1.73 meters squared is in the range of Stage 3 chronic kidney disease (CKD) if it is repeated and shown to be consistent over more than 3 months.  I would also suggest that you have a urinalysis to see if any blood, protein or infection is present in your urine.  I would agree that your blood pressure should be targeted to less than 120/80 and I recommend increased physical activity and a low salt diet.  I also recommend that you maintain a healthy body weight.  Hence, I recommend repeat testing to confirm abnormal results and then discuss your concerns with your primary care physician (PCP).

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

A couple of years ago I had elevated creatinine and BUN. I was taking a lot of NSAIDs (800mg ibuprofen in the morning and naproxen in the evening). Those values would have been elevated for only a couple of months at most. I stopped immediately and the values returned to normal and have not been elevated again since that time. Question one is could that have caused permanent kidney damage or is there even a way to know? Question two is can I take, say, 400 mg of ibuprofen occasionally or for a few days at a time and be safe in doing so?

The long term use of non-steroidal anti-inflammatory drugs (NSAID’s) has been associated with chronic kidney disease (CKD).  If your kidney function tests, such as the estimated glomerular filtration rate (eGFR) and your urine tests have returned to normal, then you may have avoided long term damage.  I am unable to comment on your use of Ibuprofen for short periods of time.  You need to discuss that with your physician who knows your complete medical history and can perform a physical examination.  It is important that your primary care physician (PCP) know all the medications that you take, including any over-the-counter medications such as Ibuprofen.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Medication and Kidney Function