Sir, could you please help me in understanding an ACR report. Following are the values.  Urine analysis report: 1. Urinary microalbumin is 59.8 ug/ ml 2.urine creatinine is  22.5 mg/ DL 3. Urine albumin/ creatinine ratio is (2.6:1)  ug/mg of creatinine  Please reply soon.

The units for microalbumin or albumin in the urine should be microgram per milligram of creatinine (ug/mg) or milligram per gram (mg/g) of creatinine.  In order to perform the calculation the units for concentration must be the same.  Hence, the units you quote for urine creatinine is the common one at milligrams per deciliter (mg/dl).  In order to use the ratio calculation, the units for albumin must be the same.  You have quoted the albumin at 59.8 micrograms per milliliter (ug/ml) which is 5980 micrograms per deciliter (ug/dl).  Now the concentration units are the same.  Hence the actual ratio result should be 266 ug/mg creatinine, which is abnormal.  Normal is less than 30.

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

I have a GFR of 45 but I am confused. One chart says I’m 3b like the doctor. But another says 3a. I don’t get it.

Stage 3 chronic kidney disease is present when your estimated glomerular filtration rate (eGFR) is between 30 and 59 milliliters per minute per 1.73 meters squared and has been so for at least three months.  Stage 3 is split in two classifications.  Stage 3a is an eGFR between 45 and 59 and has been so for at least three months.  Stage 3b is an eGFR between 30 and 44 and has been so for at least three months.  Hence, if your eGFR has been at 45 or more for three months, then you have Stage 3a classification.

This is using the classification system developed by the National Kidney Foundation and can be found at:  https://www.kidney.org/professionals/explore-your-knowledge/how-to-classify-ckd

 

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

I am medical POA for a friend who lives alone and is in end-stage renal failure. She refuses to allow me to call for hospice, and has become verbally abusive and uncooperative to those who look in on her. She cannot make it to the bathroom on time, and has had diarrhea and vomiting episodes, yet refuses to allow us to change sheets or help clean up in any way — yelling, screaming, etc. I called her doc to ask if he could prescribe anything to help calm her down — he said no, that she needs hospice. I’ve contacted hospice, and they are willing to come at any time, but without her consent, our hands are tied — and she will not give it. She has regained some appetite after going nearly two weeks of not eating much, but she vomits and has diarrhea, and complains of constant ringing in her ears. She is pitching fits because the bank changed her debit card to one that no longer has raised letters on it — irrational hate and anger. She is conveniently blind due to diabetic retinopathy, but can see what she wants to see. Can you provide any advice for how to proceed? I am at my wits’ end. Thank you.

This is a very difficult situation.  The observations that you describe sound like your friend is experiencing either delirium or dementia.  You may need to consult with a psychologist or a psychiatrist and see whether your friend in competent to make decisions for herself and whether this is delirium, dementia or something else.  If your friend is not competent, then you may need to get a legal guardianship to make all decisions for your friend. Medical or health power of attorney (POA) is not sufficient to deal with this situation and if she is not competent, then she may be suffering from the poor decisions that she is making.

 

Posted in Ask the Doctor, Chronic Kidney Disease, End of Life Issues, Kidney-Related Health Questions, Symptoms and Side Effects

Hi, I am 1 year post transplant and still experiencing side effects from medication, especially prednisone. Prednisone was eventually reduced to 4 x 5mg per week, which should have lessened the side effects, but hasn’t. In fact it’s much worse than what it was at 6 months post transplant. Now 1 year after transplant, I am still experiencing erratic moments of irritability, insomnia and aching legs and feet, these are usually worse at night. I have informed my doctor about these, and he’s told me to give it (the reduced dosage) more time to work through my system. Aside from all of that, I gained 10 kgs between May and September and when I went for a go visit on 4th October I’ve gained another kilogram which puts me at 11kgs weight gain post transplant. This weight gain, leaves me feeling very uncomfortable and beside all of that my entire body bloats from the time I get out of bed, feet, ankles, lower and upper legs, abdomen, arms, fingers, face, etc. I am not on any diuretic, I do not use salt in my diet, I try and excercise at least 4 times a week but even this is becoming a problem as my knees ache all the time and I’m finding it very difficult to even bend down or kneel as it is quite painful. I’ve informed my doctors about all of this and all they’re saying is to give the prednisone time to work. Other medication I’m using is advagraf 11mg, Myfortic 360 mg x 2 daily & a magnesium supplement which doesn’t seem to even help. What more can I do to help myself get some relief from these side effects and to lose weight or reduce the bloating? I follow a balanced diet, or at least try my best to and I don’t eat any processed foods or even drink sodas or juices. Only water, about 2.5-3 liters a day and 2 cups of decaf black coffee.

Weight gain after transplant is a very common problem.  The improvement in appetite and the prednisone after transplantation both promote weight gain.  Most of my patients comment on how good food tastes after getting a kidney transplant.   I suggest that you consult a dietitian to review your diet.  If you are gaining weight despite exercising on a regular basis, then you need to review the calories in your diet and likely need to keep a food journal that you can use to consult with the dietitian.

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

Recently I went into Stage 4 of kidney disease.  My GFR is 17 and creatinine was 3.66.   I do have high blood pressure but is pretty good with meds (140/80)…also diabetic with an avg reading of 139.  I really am watching my sodium intake and potassium (levels were good with last blood tests).  Old remedy I am told is vinegar with the mother (1 tsp per day with glass of water).  What are you thoughts or experience with this old remedy?   I do drink a lot of water to keep hydrated and flush the kidneys.

I have had many patients mention this to me.  I have never seen any study that suggest that vinegar is of benefit in patients with chronic kidney disease (CKD).  I have not observed any ill effects and I have not witnessed any benefits that have come from use of vinegar.  On a theoretical basis, vinegar is a weak acid (acetic acid) and would increase the acid load for the kidneys to deal with.

 

 

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

My son is active on the Transplant list due to a genetic kidney disease and is also a competitive college athlete. His coaches have said that because he is “not in shape” he cannot play. Often he has trouble keeping up in the conditioning program because he is fatigued easily. His GFR is 20 creatinine is 3.9 Is his kidney condition what is really holding him back or is he out of shape?

There have been several professional athletes that have had advanced kidney disease and still able to play professional sports.  Hence, kidney disease does not preclude physical conditioning but the anemia and the fatigue do make the conditioning more difficult.  I cannot tell what may be the problem with your son based on the information that you present.  His kidney function places him at Stage 4 chronic kidney disease (CKD).

 

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Serum Creatinine, Symptoms and Side Effects

I have a brother with kidney failure and he wanted to know if it is a terminal illness?

Kidney failure can be managed by conservative management, dialysis and transplantation.  Hence, kidney failure does not have to be a terminal illness, but it can be terminal without proper treatment.

 

 

 

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

I am on chemo. I have interstitial cystitis. I use macrodantin at night and the pill that turns urine orange. Can this protect my urinary tract during chemo treatment? Thanks.

Macrodantin (Nitrofurantoin) is a urinary tract antibiotic and does not have any protection against chemotherapy agents.  The urinary tract analgesic phenazopyridine (Pyridium) turns your urine orange and decrease the pain of urination but has no protection against chemotherapy agents.

 

Posted in Ask the Doctor, Kidney-Related Health Questions, Laboratory Testing, Urinary Tract Infection/Pyelonephritis

My father’s creatinine levels are high (159) and are steadily increasing. He says he’s okay but it’s affecting his blood pressure and he’s always complaining about this tension in his head. He has never smoked nor drank in his entire life, exercises a lot, in really good shape, more healthy in eating habits then any of us and is in his 40s. I don’t know if he’s kidneys are failing or what’s going on. Is this a sign/ symptom of a chronic kidney disease?

The serum creatinine that you quote is abnormal but I am unable to make any specific diagnosis based on the information that you provide regarding your father.  High blood pressure can be seen in patients with chronic kidney disease (CKD).  Your father will need to consult with his physician and have further testing performed.  Treatment for high blood pressure will likely be necessary.

 

 

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

I am a 31 year old female with PCKD. My question is how soon can I be put on the transplant list? I have frequent recurring UTIs and kidney stones. My kidney function is still in the 90’s.

Polycystic kidney disease (PCKD) is a slowly progressive disease.  You should not require kidney transplantation until your estimated glomerular filtration rate (eGFR) is less than 20 milliliters per minute per 1.73 meters squared.  The eGFR would need to be less than 20 for at least 3 months before you would be considered for kidney transplantation.  Bladder infections  (UTI’s) and kidney stones are not an indication for kidney transplantation.

 

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Kidney Stones, Kidney-Related Health Questions, Transplantation, Urinary Tract Infection/Pyelonephritis