Dear. Doctor. Good afternoon. Could you kindly explain to me the findings of my brother’s renal ultrasound please? Your feedback will be highly appreciated. Thank you in advance for your time and consideration. Age: 28 Sex: Male Indication: r/o Renal Artery Stenosis RENAL ARTERY DOPPLER/ ABDOMINAL ULTRASOUND REPORT RIGHT LEFT PSV (cm/s) EDV (cm/s) RAR PSV (cm/s) EDV (cm/s) RAR Renal Main Aet @ Ao 105 29 0.67 183 43 1.2 Renal Hilum 70 19 138 38 Interlobular atery 38 12 110 39 Aorta 157 cm/s 157 cm/s RI 0.75 0.78 PI 2.2 1.9 AT 0.130 s 0.150 s The left kidney is normal in size measuring 10.6 x 5.0 cm and contained a 3.7 x 3.0 cm renal cyst within the mid-pole. There was increased echogenicity of the left renal parenchyma and good renal perfusion. Doppler investigations of the left main and intra-renal arteries demonstrate high renal vascular resistance flow showing increased RI vascular resistance (RI=0.78) with decreased diastolic flow. Pulsatility Index (PI) and Acceleration Time (AT) were also increased. These findings strongly suggest medical renal parenchymal disease. The contra-lateral right kidney is small in size measuring approximately 6.1 x 2.3 cm. Color flow doppler and spectral doppler waveforms show abnormally poor or little renal perfusion. Doppler investigation of the right main and interlobular arteries shows increased RI and PI characteristic of parenchymal disease. This small right kidney may be due to congenital hypoplasia or pyelonephritic shrinkage. Both the left and right renal arteries demonstrate normal peak systolic velocities.

The ultrasound with Doppler of both kidneys were done looking for evidence of a blockage in one or both of the kidney arteries. The result suggest that the right kidney is very small. Men should have at least 11 centimeter kidneys. The left kidney is slightly small and shows changes of chronic kidney disease (in general this suggests scarring of his left kidney and marked scarring or atrophy of his right kidney. This could mean that the right kidney was small at birth or developed later in life. The report does not differentiate these two possibilities. There was not evidence for blockage of the kidney arteries and changes in the Doppler are more consistent with scarring and chronic kidney disease.

I am unable to provide any other specific diagnosis based on the ultrasound and Doppler findings.

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

When pregnant with my second son 4 yrs ago, it was determined I had been born with one kidney. Hypertension escalated until the beginning of this year blood pressure 250/140. The blood pressure was resistant to high doses of multiple hypertension medications. In April, I went into renal injury and in May angiogram revealed I had renal artery FMD with over 90% stenosis. An angioplasty was successful and I was fortunate to no longer need medication. Then thyroid problems began. Could my kidney and medication issues and then sudden resolve, have effects on my thyroid? It seems to be a point of breakdown when working with specialists and mystery concerns present and no real answers for. Any insight is appreciated.

I am not aware of any relationship between fibromuscular dysplasia (FMD) of the kidney arteries, solitary kidney and thyroid problems. It is relatively common for women to have thyroid issues including hypothyroidism. Younger women also have FMD of the kidney arteries, but I am not aware of any known link to solitary kidney with either FMD or hypothyroidism.

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

Good afternoon, could you kindly explain to me what exactly is meant by parenchymal disease please. Your feedback on this matter will be highly appreciated. Thank you for your time and consideration. Respectfully.

The term parenchymal disease commonly refers to a disease of the kidney substance or kidney tissue rather than a disease of the collecting system, ureter or bladder that would be urinary tract obstructive disease. In reviewing ultrasounds of the kidneys, we commonly look for increased echos inside of the kidney which can be a sign of kidney parenchymal disease. This usually indicates some kind of scarring of the kidneys.

Posted in Ask the Doctor, Kidney-Related Health Questions

I am writing about my mom, 79 yrs young. She still hauled grain to the elevators this summer in the grain trucks. As of late, the GP has had some concern of anemia, and some leg swelling. A few months ago she had emergency gall bladder removal surgery, and several days later kidney function declined significantly, gfr was down to 15. After a few days and testing, the situation corrected itself to gfr of 51 The GP sent her to nephrologist. He did a battery of tests. CBC RBC 3.69, Hemoglobin 11.3, Hematocrit 34.5, ESR elevated to 55, Iron, IBC and Ferrtin, in normal ranges, IFE and PE are within normal vales, no M spike observed. LD normal range. Bun 29, creat 1.0, albumin 2.9, BUN/Cret 27.9, UA protein 71.1 mg/dl, UA creat 133.7 md/dl, UA protein/creat ration 0.532, Uric acid 8.2 mg/dl, Free Kappa Lt Chains 63.4 (H) mg/L (3.3-19.4), Free Lambda Lt chains 78.3 (H) MG/L (5.7- 26.3) But Kappa/Lambda radio is 0.81 (.26-1.65) which I was told was good. Blood smear was unremarkable, reds and whites of normal size and shape and appearance. Doctors unsure. Nephrologist was not concerned, and didn’t think kidney disease would progress (stated stage 3a ckd) so no special instruction or diet, other than avoid NSAID. GP thought Iron problem, but iron test show otherwise. Endocrinologist not sure, happy with A1C 7.0, using Lantus and R on sliding scale. Only other meds are Sotalol antiarrhythmic for a. fib, and a statin. The only thing that was not run was an EPO level, with the comment made that the kidney disease was not severe enough to cause a problem with EPO causing the anemia. Reading, many of the above could be explained by chronic kidney disease. Any ideas or impressions ? Thank you

I am not able to make a specific diagnosis based on the information that you present. Since she has diabetes, heart disease with atrial fibrillation, and a recent episode of acute kidney injury, she does have significant risk factors for chronic kidney disease (CKD) besides her age (79). She has excess protein in her urine. The normal protein to creatinine ratio is less than 0.2 and her level is 0.53. Hence, she could qualify as having diabetic kidney disease or this still could be residual of her recent episode of acute kidney injury. She has mild anemia which could come from her episode of acute kidney injury or from her CKD. I do not think that measurement of an erythropoietin (EPO) level is indicated, but I also think that this degree of anemia does not need to be treated.

I suggest continued followup with her primary care physician (PCP) and her nephrologist.

Posted in Acute Kidney Injury, Anemia, Ask the Doctor, Chronic Kidney Disease, Diabetes, Kidney-Related Health Questions, Nephrologist

I have 1 kidney ( having lost the other to a staghorn calculi, 24 Lithotripsy, Stents and infections -it died off and was removed). My gfr has dropped from 54 in August to 36 on Tuesday. My nephrologist doesn’t seem in the least concerned. His office says he’ll see me in February as planned. Am I wrong to be concerned? I lost my right kidney in 97. Since then I have lived between 50 and 60% function in the left kidney.

Normal estimated glomerular filtration rate (eGFR) for someone with a single kidney is usually within the range of 50 to 60 milliliters per minute per 1.73 meters squared. It is true, that with aging, the eGFR may decline over a number of years. A single low measurement could be a temporary problem, or a laboratory error, or other issues. If you remain concerned, you may need to discuss your concerns with your nephrologist. In some cases, merely repeating the test to make sure it is accurate is all that may be needed. I would also suggest annual testing for blood, protein and infection in the urine.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Nephrectomy / One kidney, Nephrologist

I was diagnosed with CKD (Stage 3a) in 2016. Additionally, I have bi-lateral atrophic kidneys (most likely caused by a presciption multi-drug overdose from a suicide attempt in 2007). I have osteoarthritis in several joints and was recently informed that I must wait until March 2018 to be able to have anymore corticosteroid injections due to the number I have had within the past 12 months. I have been prescribed oxycodone 5mg BID for my right shoulder and cervical spine pain. Presently, the pain I have in my right acromioclavicular (AC) joint is severe. I do not take NSAIDs. However, my nurse practioner stated that it is okay for me to take ibuprofen on an occasional basis. It helps moderately, but I am concerned about using ibuprofen & it increasing the progression of my CKD. (I’m a 64 year old female with pre-diabetes [recent A1c 5.9] and I have hypertension that is well controlled with losartan 25mg qd. I am receiving physical therapy; I use alternating heat/cold compresses & I am using TENS therapy to help manage the pain). How often can I take ibuprofen? Hours, days? (I am concerned about oxycodone addiction if my physician increases the frequency). Thank you for your response. P.S. My mental health has been extremely stable since January 2008 with no suicide attempts or thoughts of harming myself.

The use of long term treatment with non-steroidal anti-inflammatory drugs (NSAID’s) such as Ibuprofen is not a good idea for patients with chronic kidney disease (CKD). In general, I occasionally recommend very short courses of NSAID’s to treat acute pain or injury but there is no indication for intermittent treatment of chronic pain with NSAID’s in patients with CKD. If you have chronic pain, it may be necessary for you to consult with a chronic pain specialist and seek ways to avoid use of NSAID’s.

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

My husband has a swollen kidney for the last five years, along with blood in the urine for much longer than that. I am very worried about him as he seems to be getting worse. If he sits still, he is falling asleep. He is in constant pain and has severe pain that comes and goes. His kidney according to the CT, MRI, and Ultrasounds is enlarged every time. He is a veteran and goes through the VA. Neither one of us has faith in his Doctor anymore. He tells him he doesn’t know what is wrong. Can you recommend a kidney Dr. in central Fl that can help him.

I am not sure how specific of a diagnosis can be made about a “swollen kidney”. That is not a medical diagnosis. The fact that one kidney is swollen more than the other is unclear. There are a number of causes for unequal kidney size including being born with different kidney sizes. Neither I nor the National Kidney Foundation provide referrals. I suggest you ask his primary care physician (PCP) for a referral to either a urologist or a nephrologist, if he or she is unable to offer a reason behind one kidney larger that another.

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

Is Puf bad for your heart. My mother-in-law has end stage renal failure since September of last year. She also has fluid going to her lungs, so she goes to dialysis Monday, Wednesday and Friday and then Saturday they do the puf. I am concerned that doing this can damage other organs in her body. Do you know if she can continue doing it to keep the fluid out of her lungs? Thank you.

I am not familiar with the abbreviation (acronym) “PUF”. From your description, I suspect this is some type of ultrafiltration treatment (pure ultrafiltration). Ultrafiltration means that the dialysis machine is set up to remove fluid only and not perform any dialysis (clean the blood). Pure ultrafiltration then would mean that this was a way to remove fluid from the lungs without cleaning the blood. This is commonly done in patients who have a very poor heart, patients who drink excessive quantities of water, take in excessive amounts of salt, or who have very unstable blood pressures and require more frequent fluid removal than three times per week, in order to keep fluid out of the lungs.

I suggest that you address your concerns to the nephrologist who is caring for your mother-in-law.

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

Doctor, we have a 10 year old who has had multiple strep infections, was thought to have had glomerulonephritis at that time. Then as a precaution had tonsils out, now at age 21 with no other infections present has the same kidney symptoms without infection. Can this be due to exposure to chemicals at his work?

I am not able to make a specific diagnosis based on the information that you present. It is true that streptococcal infections can be associated with inflammation within the kidneys (glomerulonephritis). In some cases, this may require a kidney biopsy in order to know what is causing the disease. The decision to perform a kidney biopsy must be based on the potential risks of the biopsy versus the benefit of knowing the diagnosis and any potential treatment that may be indicated for a new diagnosis. I don’t know what chemicals he was exposed to at work so I cannot comment on environmental exposures.

Posted in Ask the Doctor, Glomerulonephritis, Kidney Biopsy, Kidney-Related Health Questions

I have been suffering IgA nephropathy about 30years. I am now 49 years woman. My disease is not severe, just protein and hematuria in my urine. I have ACE medicine, for keeping my blood pressure solid because I have no high pressure. I have read studies where it’s said, that they have found diet without gluten (maybe dairy and red meat too) has been useful and protein has decreased and the glomerulus has gotten better. Is it worth it to leave gluten and maybe dairy and red meat out on diet to help my kidneys?

There are many theories about the cause of IgA nephropathy that include dietary causes such as gluten and other foods in the diet (as you mention). These remain theories because no study has yet shown that adjusting the diet in patients with IgA nephropathy will result in any improvement of the disease. My standard treatment for IgA nephropathy includes use of ACE-inhibitors or ARB agents, low salt DASH diet and in some cases fish oil. I sometimes have used steroids for patients with more rapid disease, scarring disease of the kidney and increased amounts of protein in the urine (proteinuria). I have not yet subscribed to the idea of limiting gluten or dairy products in the diet. You can review the DASH at:  https://www.nhlbi.nih.gov/health/health-topics/topics/dash

Posted in Ask the Doctor, Diet/Nutrition, IgA Nephropathy/IgA Dominant Glomerulonephritis, Kidney-Related Health Questions, Proteinuria