Hi, I’m considering a trip to Madagascar where malaria prophylaxis is recommended but I’m worried that these drugs are not kidney-friendly. The drugs listed by the CDC Travel Health site are: Atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine. I have had one kidney removed almost two years ago (renal carcinoma totally encapsulated) and my numbers are good if a little toward the low side (GFR has climbed from 43 to 47, Creatinine improving from 1.31 to 1.21, BUN in normal range). Would I be able to take any of these or should I give up on traveling to malaria-infested countries? Thanks much!

Tafenoquine does not have any dosing information for patients with chronic kidney disease (CKD). Atovaquone/Proguanil should not be used if the creatinine clearance is less than 30 milliliters per minute. The rest of the medications that you mention do not require any dose adjustment for patients with CKD. Hence, your physician should be able to find you malaria prophylaxis that is safe for you to take.

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I have high blood pressure, well-controlled on medication for >10 years. At my last annual doctor visit, my bloodwork showed a blood sodium level of 125. My BP that day was 110/68. I take 50 mg atenolol and 25 mg hydrochlorothiazide daily, have lost 50 pounds in the last 18 months through diet and exercise. I drink a lot of water daily; the morning of the lab test, I was fasting and had drank 3 liters of water in the course of 4.5 hours. My doctor made me stop the diuretic for 3 weeks and retest; came back 124. Blood pressure shot up to 168/99; doctor was not concerned one BIT with that (or the accompanying edema in my feet, calves and ankles); only wanted me to be admitted to the hospital and referred to a nephrologist. She said I had “severe hyponatremia” and could die! I have ZERO symptoms of hyponatremia; when I refused her recommendation, she fired me from her practice and cancelled all of my prescriptions. Now my NEW doctor says I have “CHRONIC hyponatremia” based on two blood tests; blood sodium in early January of this year was 134. Why would I have zero symptoms if I’m so “sick”? And, would 3.5 months’ time be considered “gradual” or “sudden” onset?

Low blood sodium (hyponatremia) is relatively common in patients who take hydrochlorthiazide and drink an excess of water. The most common symptom of hyponatremia is gait instability and falls. This is more common in the elderly. One of the more common causes of hip fracture in the elderly is hyponatremia. You may require further testing. It is true that hyponatremia can be life threatening in that a serum sodium less than 120 milliequivalent per liter (mEq/L) may cause seizures and brain injury.

I was recently diagnosed with stage 3 CKD. My GFR is 42.2 and my creatinine is 1.24. Everybody tells me what not to do but are there things I can actually do to raise my numbers?

The nature of chronic kidney disease (CKD) is to cause the destruction of kidney filters known as glomeruli. There are no treatments that directly cause the kidney to build new filters (glomeruli). Once a kidney has been damaged and the filters have been damaged, new filters cannot be manufactured. Hence, the goal in treatment of CKD is to prevent further damage. In some cases, these kidney numbers may go up and down as a result of laboratory variation, but the underlying kidney disease is still present. Some damaged filters that have not been completely destroyed may transiently improve function, but the destructive process is still present. Avoiding further injury by not smoking, controlling your blood pressure, controlling your diabetes, avoiding non-steroidal anti-inflammatory drugs (NSAID’s) and leading a healthy lifestyle are very important. Following a low salt diet, exercising and maintaining a healthy body weight are parts of a healthy lifestyle.

Is it safe to take Tylenol with Codine, low dose aspirin or extra strenth Tylenol for pain?

Yes. In patients with chronic kidney disease (CKD), Tylenol (acetaminophen), codeine, and aspirin can generally be safe. I do suggest that you check with your physician about taking these medications safely with other medications you may be taking.

Suffering from ckd 5. Is there any chance to cure the disease without transplant or dialysis?

Chronic kidney disease (CKD) Stage 5 means that there has been a permanent loss of over 85% of kidney filtering capacity. This cannot be replaced or recovered. Hence, for CKD Stage 5 the only ways to manage are dialysis, transplantation or conservative management with the decision to forgo any treatment.

Hello. My now, 5 year old son, when I was pregnant, he had fluid on his kidneys and was born with hydronephrosis. He had his checkups every 6 months up until we moved to another country in 2016. He was doing OK. No problems up until 2 months ago, he had been complaining of back pain, so I took him to get a sonogram to check fluid and he had little, not as much as he had before, and he had blood and urine tests done. The tests came back that he had a kidney infection. He was put on antibiotics. After he finished his medicine, the pain continued so I took him to a kidney specialist and all he did was tell me to go get him a US renal sonogram and get his urine and blood work. So I took him to get the sonogram. Doctor said he had no fluid on either kidney. The right kidney was 86x33x37mm and 10.6mm, his left was 82x33x39mm and 13mm. Doctor said no fluid on his kidneys, which was a relief but she said his spleen was swollen. She told me a child his age should be 105mm but my son was 116mm and she told me to wait for his blood and urine test results to come back to see if it’s from an infection or if not, then it’s normal. I am still waiting on his results but my question is what should I do next? Who should I take him to next? Should I worry with us being in another country? The health care is not anywhere close to the United States and that has me worried. Do I take the results and sonogram information back to the kidney specialist or should I see someone else? Any and all help and information would be very much appreciated. If you need more information or any questions, please contact me.

I am an adult nephrologist and I have no expertise with children. I would offer two recommendations. In most cases, I would have your son evaluated first by a pediatrician, rather than going directly to a kidney specialist. A pediatrician can evaluate any and all of your son’s medical problems and offer you suggestions on where to go and seek consultation. Secondly, if you have not consulted with a urologist, then a urologist would be the proper person to evaluate your son’s history of hydronephrosis and to evaluate the ultrasound information. A urologist is a surgeon, who deals with the kidneys and lower urinary tract. I, as a nephrologist, have no surgical expertise.

My mother is in stage 4 kidney failure and is in fluid overload. Her nephrologist just upped her Lasix to 320mg per day. She has had fluid on her for 6 weeks now and was in the hospital for 1 week. She has been at the local nursing facility for 4 weeks now and the fluid is not going down. Tomorrow will be 72 hours since doctor raised her Lasix dosage yet she seems to not be able to urinate frequently enough to get fluid off of her arms, hands, feet, and legs. Is there any way to help get fluid off of her? Her gfr is 19 to 20. Any suggestions would be greatly appreciated.

Resistance to the effects of diuretics is a common feature of advanced chronic kidney disease (CKD). In some cases, dialysis is the only alternative. In some cases, the diuretics can be delivered directly into the vein so as to increase their effect. There are other alternative diuretics that can be tried. Her nephrologist should be made aware of this. She is on a very high dose of Lasix (Furosemide) and in some cases, this can cause toxicity to the ears. I suggest that you review your concerns with your mother’s nephrologist. I am unable to recommend medical treatment without performing a complete history and physical examination.

My father is has a 2.90 creatinine. What are the options for him?

I am not able to make a specific diagnosis based on the information that you present. Your father appears to have kidney disease, however, I am unable to tell if this is acute kidney disease or chronic kidney disease (CKD). I suggest that you review this with your father’s physicians and ask for a specific diagnosis in regards to his kidney disease.

Just listening to nephrologists podcasts and reading a lot! I have high BP (3 meds) that is not well controlled at all, I’m reading ACE inhibitors are a MUST! I’ve never been prescribed one. My potassium is well within normal limits, I stopped all salt a long time ago, my weight is excellent…my question is why haven’t I been prescribed an ace inhibitor to help control my BP? Also, my PCP refuses to raise or change my diabetes meds! My blood sugar is very high (often 300) I’m on a minimal dosage of Januvia 25 mg once daily. Why? I feel I’m the only one on my Renal team doing anything to slow the progression of my CKD. I’ve been seeing a nephrologist for years…she does nothing more than labs! I’m vegetarian, watch phosphorous, low carbs, no alcohol ever etc. Please advise.

I am not able to answer your questions about your current medical care. I suggest that you review your concerns with your physicians. I find patient advocacy is very helpful in seeking answers to your questions about your current medical care. I agree that you should have answers to your questions.

I’m a 25 year old female and had a left pyeloplasty 3 years ago to resolve a recurring hydronephrosis issue (left kidney only). Since the surgery my pain has not lessened, but at my six month post-op appointment, my surgeon said that function looked fine, so we haven’t pushed any further. Pre-surgery I experienced left sided flank pain, as well as pain that would spread up and down the entirety of my left side of my body. I still experience this now, plus lightheadedness, light sensitivity, extreme fatigue, and confusion (that resulted in me being stroke-coded last year). It was pointed out to me by someone working on my back (also about a year ago) that the back left side of my rib cage is raised higher than the right side, at the same trouble spot that’s always been painful. I’m curious if any of this sounds like it’s even related to the initial issue for which I had the surgery. It’s been difficult to connect the symptoms but I’m starting to doubt that the root cause is kidney-related at all. Thank you!

I am a nephrologist and have no surgical expertise. The problem that you are describing is pain after surgery. This could be a urological problem. A urologist is a surgeon who deals with both the kidneys and the urinary tract. Pain is a very uncommon sign of kidney disease but can be associated with lower urinary tract disease.

I am not able to provide a specific diagnosis for the symptoms that you present. I would suggest that you first start with a general history and physical examination with your primary care physician (PCP) and get some guidance as to what further testing may be needed. A PCP can give you better guidance as to what are the most likely causes of your symptoms.