This is for my husband, 58 years old. Last year, June, his serum creatinine was 1.23 and GFR WAS 65. This week tested it was 1.4 and GFR 55. He has high blood pressure. Fasting sugar 111. Prostate enlargement. Yesterday, consulted a doctor and suggested calcitriol 0.25, temulose and minnamineforte. Let me know is it safe taking calcitriol or not. I fear it may cause any adverse condition.

Calcitriol is an active form of vitamin D and is commonly used in the treatment of bone disease and secondary hyperparathyroidism in patients with chronic kidney disease (CKD). I am unable to recommend specific medical treatment without performing a complete history and physical examination.  I suggest that you visit with your husband’s physician about your concerns.

 

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Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Treatments

I have nausea and urge to throw up, associated with left side kidney pain that radiates to the front lower abdomen. I have had these episodes come and go throughout a time frame of 2-3 years. I recently also took a hard fall off of a bike, and came home in pain worse then I’ve ever felt before on my left kidney. I noticed a few drops of blood in iron. I am worried. Please, any advice of what you think it might be? I truly would appreciate it. Thank you.

I am unable to make a specific diagnosis based on the information that you present.  Further testing will likely be necessary in order to determine the cause of your discomfort.  A complete history and physical examination by your physician should help to localize the problem and then further studies may be needed to visualize the problem.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects

I am a 76-year-old white male. A year ago I had an eGFR of 45 mL/min/1.73m2 and a P/C ratio of 9,600 mg/g. After taking Valsartan 80 mg once a day since then, my current eGFR is 46 and P/C ratio is 1,080 which is a radical drop in my P/C ratio. All other things being equal, is my prognosis the same as another person who has a P/C ratio of 1,080 without taking Valsartan 80 mg once a day?

I don’t know any way to answer your question because there has been no study comparing people with and without an angiotensin receptor blocker (ARB) agent such as Valsartan who have had a response to Valsartan in the first place.  I would consider this to be a very good response to Valsartan.  The decline in proteinuria is the desirable response to treatment with Valsartan and the response you report would be a very encouraging response from my view.  The fact that your estimated glomerular filtration rate (eGFR) did not change is also a very good sign.

 

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

My father has Stage 4 kidney disease as a result of all the NSAID’s taken prior to hip replacement surgery. Currently his BPH is acting up and he is unable to empty his bladder. A catheter has finally been inserted. We cannot get an appointment with a Urologist until 3 weeks from now. His legs are swollen. How concerned should we be about his kidneys?

Blockage of the bladder can cause worsening of his underlying chronic kidney disease (CKD).  His physician should be monitoring your father’s kidney function with blood testing.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Urological Issues

I donated a kidney in 2014, have started to have pain where the missing kidney was, left side. Normal or not. Just trying to save a trip to Dr. office, money is funny for me right now.

I am a nephrologist and not a surgeon.  I have very little experience with kidney donors after they donate a kidney.  I have not heard of late pain after kidney donation.  I suggest you consult with your physician for an examination.

Posted in Ask the Doctor, Kidney-Related Health Questions, Laboratory Testing, Living Donation, Nephrologist

Can I use Megestrol Acetate to improve my appetite while on dialysis? If say OK then what is the maximum dose I can intake?

I have used Megestrol in patients on dialysis for stimulation of appetite.  I have found it to be inconsistently effective.  I cannot recommend medication and dosing without performing a complete history and physical examination.  I suggest that you discuss this with your physician.

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

My bloodwork shows a creatinine level of 2.21 and GFR of 22. I can’t get in to a nephrologist until the end of November. Should I be concerned about waiting 6 weeks for an appointment? Thank you.

Your primary care physician (PCP) should be the best person to advise you in this regard.  This would depend on whether the changes in your kidney function have been rather sudden (such as acute kidney injury) or whether the changes have occurred over a longer period of time (such as chronic kidney disease or CKD).  There is also consideration of your underlying health status.  I suggest you discuss the referral to a nephrologist with your PCP.

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

My wife, 66 yo, was recently diagnosed with kidney disease early stage kidney failure. Her protein numbers, etal remained somewhat steady for 6 months but on her last two labs they have shot up so the doctor ordered more aggressive treatment which includes prednisone and 2 chemo sessions. She never had a kidney biopsy and cancer has never been diagnosed. In fact by process of elimination the diagnosis is hereditary and high blood pressure. My wife did not ask why chemo if no cancer but I am really upset about it but don’t want to alarm her. Could there be another reason for the chemo? Thank You.

In order for your wife to receive chemotherapy for kidney disease, it is commonly necessary for your wife to sign a permit that she has received informed consent about the use of chemotherapy.  If your wife has not received informed consent to perform chemotherapy, I suggest you and your wife discuss this with the physician in charge of her care.  There are sometimes when a kidney biopsy is not possible, but I usually perform a kidney biopsy before embarking on aggressive chemotherapy for kidney disease.  Chemotherapy is sometimes done for certain forms of kidney disease such as vasculitis, lupus, and certain forms of nephrotic syndrome.

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney Cancer, Kidney-Related Health Questions, Lupus, Nephrotic Syndrome

Hello, I have CKD stage 3, microscopic blood in urine. My urologist ordered CT scan w/o contrast and then mentioned maybe a cytology in which contrast would be used. He did not seem concerned about using contrast. Just a bit concerned myself. What are your thoughts please?

If contrast is to be used for a computerized tomogram (CT) scan, the risks and benefits of the contrast should be discussed with you. I do not know anything about the use of contrast for “cytology”.  This does not make sense to me.  Blood in the urine can be concerning for growths and stones, which often require contrast to better visualize the urinary tract.  I suggest you discuss your concerns with the urologist.

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

I am 65 years old male with stage 3a CKD. All of my blood and urine work is in normal ranges but my eGFR is 50-53 and creatinine is 126. I have blood pressure well controlled with Losartan and Norvasc 110-115/ 75. I follow a DASH type diet. A nephrologist consult, which I asked my PCP for, said my numbers are all normal and did not recommend any dietary modifications other than healthy eating habits and that I could do some research on a lower protein diet if I wanted to. I am fearful of developing MBD. My serum phosphorus is 1.4 mmol/l, the lab range is .8-1.5. My calcium is 2.34 mmol/l, the lab range is 2.1-2.6. My PTH intact is 6.5 pmol/l, the lab range is <7. The consult review letter from the nephrologist to my doctor said I was extremely healthy. I find this comment puzzling given that my eGFR is less than 60. She also had me do a 24 hour creatinine clearance which showed a calculated GFR of 67. I don’t know who or what to believe anymore I am so confused. Should I be following a low protein, low phosphorus diet? Am I in danger of progressing to MBD? I am very scared.

The situation that you describe is very early Stage 3a chronic kidney disease (CKD).  If no other causes were found with your nephrology consultation, it is likely that you have CKD related to your high blood pressure and with your blood pressure very well controlled with medication and diet, you may not need any further treatment.

The information that you present suggests that you do not have metabolic bone disease (MBD).  It sounds like that everything you are doing to treat your kidney health is appropriate.

Hence the goal for your treatment is to slow progression of your CKD with careful blood pressure control and diet.  I do not advocate for protein restriction with Stage 3a CKD.  I am an advocate for the DASH diet that you are following.

There is some loss of kidney function with aging, so halting your decline in the estimated glomerular filtration rate (eGFR) is not likely.  You should follow your current treatment and have urine and blood testing for the CKD at least once per year and consult with your physician at least once per year.

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, GFR, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Nephrologist