My dad has one kidney. Three times in the last year he has experienced severe leg pain and vomiting leading to hospitalization. They tell us it is low sodium but how does he prevent this?

There are many causes of a low blood sodium (hyponatremia). There are many drugs that cause hyponatremia including some diuretics, thyroid disease, heart disease, dehydration syndromes with water replacement, liver disease, kidney disease, lung disease and adrenal disease. Hence, in order to know how to correct the problem, it is necessary for the physicians caring for your father to make a specific diagnosis and then start specific treatment for that condition.  

The criteria for determining CKD is very confusing to me. As you know, the Merck Manual lists 5 stages of CKD. From reading some of your past posts it appears that you consider eGFR 60 or above to be normal. I have read that one of the following must be present for > or = three months to be CKD: GFR 29, or other markers of kidney damage. According to this criteria, it appears to me that stages 1 & 2 of CKD as defined in the Merck Manuel are completely ignored. Please explain.The other question I have is that the National Kidney Foundation website states that 37, 000, 000 adults have CKD in the US. There is no explanation as to what that number includes. That seems to be a lot of people to be in stages 3,4, & 5 so does that number include stages 1 & 2?

There are 5 Stages of chronic kidney disease (CKD) that have been proposed by the National Kidney Foundation (NKF). The estimating equation that we use to calculate the estimated glomerular filtration rate (eGFR) is most accurate and consistent when the eGFR is 60 milliliters per minute per 1.73 meters squared or less. Hence, if we are going to use the eGFR only to make a diagnosis of CKD, it is best when the eGFR is less than or equal to 60.

Stage 1 CKD is indicated when there is abnormal urine (such as blood, protein or infection) that is present for at least three months, there is an abnormal ultrasound such as polycystic kidney disease or an abnormal kidney biopsy AND the eGFR is normal at between 90 and 120. Stage 2 CKD is indicated by urine or ultrasound abnormalities or a kidney biopsy that is abnormal for at least three months AND the eGFR is between 60 and 89. Stage 3 CKD is diagnosed if the eGFR is between 30 and 59 AND is present for at least three months. No urinary or other findings are required but are confirmatory for CKD. Stage 4 CKD is an eGFR between 15 and 29 for at least three months. Stage 5 CKD is an eGFGR less than 15 and present for at least three months.  You can learn more about CKD Staging at our web site at: https://www.kidney.org/professionals/explore-your-knowledge/how-to-classify-ckd

The estimate for CKD recently posted on the NKF web site is from the Centers for Disease Control and can be found at:  https://www.cdc.gov/kidneydisease/pdf/2019_National-Chronic-Kidney-Disease-Fact-Sheet.pdf

A majority of the people with CKD are in Stage 1 or 2 and unaware of their kidney disease.

Hi there. I got some test results in today and the note said to come here. GFR MDRD Af Amer 99 See Note See Note. GFR is estimated using Creatinine, age, gender and race. Patient’s values should be interpreted as a trend. Below 90 ml/min/1.73m2, the patient may have renal disease.

The result mentioned is that your estimated glomerular filtration rate (eGFR) is 99 milliliters per minute per 1.73 meters squared if you are African American and 81 milliliters per minute per 1.73 meters squared if you are non-African American.

In order to diagnose chronic kidney disease (CKD), your eGFR must be in a stable range for at least three months and you must also have testing of the urine for blood, protein and infection.  Hence, you will need to review the results with your physician in order to determine if you need further testing.

For more information about CKD, you can also visit our web site at:  https://www.kidney.org/professionals/explore-your-knowledge/what-is-the-criteria-for-ckd

I am diagnosed with cresentic form of IgA nephropathy. The summary of kidney biopsy (Renal biopsy (IF and paraffin)) are following,1) Consistent with IgA Nephropathy with crescents (5 fibrous; 2 fibrocellular)2) Moderate tubulo-interstitial chronicity (20-25%).3) Hypertensive nephropathy. My creatinine number was 3.51mb/dl and there was trace amount of protein and blood in my urine. After 20 days prednisone treatment (50mg), my creatinine drops to 3.13 mg/dl. I usually take plant based diet. Right now, I am perfectly ok. Please advice me on this. What this data tell about my overall health. What precautions should take regarding this disease in future. Thank you. Regards

I am unable to provide medical treatment recommendations without performing a complete history and physical examination. Immunoglobulin A (IgA) nephropathy is a relatively common form of glomerulonephritis but when associated with crescents (scars around each glomerulus) then it can be a very aggressive form of glomerulonephritis. Blood pressure control with use of ACE-inhibitors or ARB agents is very important.  Aggressive forms of IgA nephropathy are commonly treated with corticosteroids and cyclophosphamide. Plasmapheresis has been advocated by some nephrologists. Recent studies suggest that treatment of patients with IgA nephropathy and significant protein in the urine may benefit from treatment with Sodium GLucose co-Transporter 2 (SGLT-2) inhibitors.  These are drugs such as empagliflozin, dapagliflozin, or canagliflozin. Steroids such as delayed absorption Budesonide has recently been shown to be of some benefit in patient with IgA nephropathy. A new drug known as Sparsentan has recently been approved for treatment of some forms of IgA nephropathy. Fish oil treatment has also been advocated by some nephrologists.

I suggest that you discuss these forms of treatment with your nephrologist and see which forms could be beneficial for you.    

The nephrologist that my husband, Robert, is seeing is not giving us enough information. Robert has Focal and Segmental Glomerulosclerosis (FSGS). Can the latest kidney medication for CKD help him? The 3 mg morning and 2 mg in evening Bumex he’s been taking is leaving him with edema. Safe to take more? Of course I won’t change meds without consulting with his neph. Latest labs show deterioration from a month ago. He’s still urinating. When will he need dialysis? BUN 77 mg/dL 7 to 25 mg/dL HCreatinine 4.26 mg/dL 0.70 to 1.28 mg HEGFR 14 mL/min/1.73m2 > OR = 60 mL/min/1.73m2 LBUN/Creatinine Ratio 18 (calc) 6 to 22 (calc) Sodium 142 mmol/L 135 to 146 mmol/L Potassium 5.5 mmol/L 3.5 to 5.3 mmol/L HChloride 112 mmol/L 98 to 110 mmol/L HCO2 20 mmol/L 20 to 32 mmol/L Calcium 7.3 mg/dL 8.6 to 10.3 mg/dL LCollected on 03/14/2023.I just sent you a question about my husband. He is dumping lots of protein and is getting weaker and weaker. The neph tried steroids, which put my husband in the hospital. He apparently had bacterial infection of bowel. We reported to doctors black stool diarrhea (3-4 times a day) for several months, and steroids kicked it into emergency. Now he’s on Tacrolimus 1 mg 2 times a day. Is there anything better to stop the protein dumping? In just 2 weeks his energy level has dropped. He sleeps most of the time. He also had Parkinson’s, showing when he was 64. He’s now almost 79. Plus asthma, diabetes, back/neck pain from arthritis. Blood pressure is under control by 2 meds. He’s also taking 65 mg iron 2 times a day and no longer has chills, so it’s helping. Hemoglobin is just over 10 and getting Procrit shot once a week. Don’t know if it’s helping.

Focal and Segmental Glomerulosclerosis (FSGS) is a chronic scarring disease of the kidneys. It is often relentlessly progressing and associated with large amounts of protein loss in the urine. The protein loss is known as “nephrotic syndrome”.  Steroids and drugs such as tacrolimus are often used to treat the disease but these treatments are often not successful.  

Your husband has very advanced kidney disease and may require the initiation of dialysis in order to correct the nephrotic syndrome and edema that is present. At this late stage, it is unlikely that any medication will reverse the illness.  

My primary care doctor has diagnosed me as having stage 4 kidney disease for the last 2 years. She suggests cutting out wine and drinking water….should I consult with another Doctor for treatment, such as a Urologist or Nephrology doctor?

I am unable to make a specific diagnosis based on the information that you present. I’m not sure I understand the recommendation between wine and water. I often recommend that patient with Stage 4 chronic kidney disease (CKD) be referred to a nephrologist for planning purposes if there is any possibility that dialysis would ever be considered.  

Hello, I am a 40 year old female. My eGFR has decreased from 90 to 75 in the past year with corresponding increase in creatinine (from 0.7 to 0.9). I am not the best in drinking enough water (less than a 1L per day) and use about 2000 mg of aleve 2 days a month for menstral relief. Non diabetic and no hypertension. Is this reversible with increase in hydration and decrease use of NSAIDS or does my kidney have a permanent issue? Kindly advise.

This may not represent any change at all. The day to day variability of the laboratory test for serum creatinine may vary plus or minus (+)0.2 milligrams per deciliter (mg/dl). Hence, the difference of 0.7 and 0.9 mg/dl is within normal laboratory variation. The normal for an estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per minute per 1.73 meters squared. Hence, your kidney function may be normal. In order to complete testing for chronic kidney disease (CKD), I suggest that you also have urine testing for blood, protein and infection.  

Limiting use of non-steroidal anti-inflammatory drugs (NSAID’s) such as Motrin, Ibuprofen, Advil, Aleve and Naproxen is always a good idea.  

I had kidney stones in both kidneys in July 2016. The right kidney had a stone of 16mm. I’ve just been for an ultrasound and been told the right kidney has doubled in size is not working and is calcified and the left kidney has a 7mm stone. I am a bit shocked and worried. Can anything be done?

I suggest that you consult with a Urologist. A urologist is a surgeon who deals with surgery of the kidneys and urinary tract. I am a nephrologist and have no surgical expertise. A urologist has the expertise to deal with stone disease and the surgical approach to relieve blockage of the kidney.  

Hello Doctor , I was involved in a rear end car collision ; within 2 weeks, my Doctor advised me that I had a 10mm kidney stone blocking my ureter . My question is : can the trauma of a car accident cause a kidney stone to move towards and block your ureter? I am 60 years old , never have ever had an issue with kidney stones in my life .

Kidney stones are quite common and one out of six men will suffer a stone event in their lifetime. Auto accidents also commonly occur.  I am not sure that an auto collision can actually cause a stone to form but it could dislodge an existing stone and make is it symptomatic. Once the stone is dislodged within the kidney, it can cause blockage of the kidney.  

Can I get Kerendia If I have CKD but not diabetes?

Kerendia (Finerenone) is recommended for Type 2 diabetics with chronic kidney disease (CKD) and protein or albumin in their urine. At this time, we do not have information about the use of Kerendia in patients with normal kidney function or patients who are non-diabetic. 

My husband has a kidney stone of 16mm.

Your husband should be seen by a Urologist. A urologist is a surgeon who deals with surgery of the kidneys and urinary tract. A 16 millimeter (mm) kidney stone is quite large and is unlikely to pass without some type of urological intervention. I am a nephrologist and I have no surgical expertise. 

Hello, I just submitted a question from my phone and it had some errors. I would like to repost the question after I revised it: I am a 48-year-old man who received a diagnosis of stage 2 CKD approximately four years ago. My eGFR hovers around 62, and my creatinine levels have fluctuated between 1.21 and 1.32. I do not have hypertension or diabetes, and I have a normal BMI.Some years ago, I visited a nephrologist who conducted a cystatin C test and told me that eGFR is not always accurate due to various factors that can affect the calculation. The doctor also explained that creatinine is no longer the gold standard for diagnosing CKD, and suggested that I ignore the CKD diagnosis. However, I did mention to the doctor that in my 20s, I had taken creatine supplements and followed a high-protein diet for several years to build muscle, which may have contributed to my current kidney function. Additionally, I may not have consumed enough water for several years and could have been dehydrated while consuming a fair amount of sugar. Although my blood sugar has always been normal, I still worry about my CKD diagnosis and the possibility of progressing to stage 3 CKD, which could lead to cardiovascular problems and even an early death.I would like a thorough explanation to better understand my kidney function and CKD diagnosis. Despite my Cystatin C test results being normal, I am concerned that my kidneys are not filtering creatinine correctly, which leads to my low eGFR. I would like to know if my kidney function is normal or abnormal and if I have CKD. It is vital for me to comprehend my situation so that I can take the necessary steps to maintain my health and possibly prevent further kidney damage. I appreciate your assistance and your understanding of my concerns.

The serum creatinine is used as a marker of kidney function. There are several assumptions that are made in order to use the serum creatinine in the estimating equations for the glomerular filtration rate (eGFR). One of the assumptions is that you have an average muscle mass. The serum creatinine is directly proportional to your muscle mass and inversely proportional to your eGFR. The true glomerular filtration rate (GFR) is what we are trying to approximate when we are measuring kidney function.The true GFR is most accurately assessed by inulin clearance or iothalamate clearance.  Both of these tests are expensive and laborious to perform. Hence we use other “markers” to estimate the eGFR such as creatinine or Cystatin C. You can access the CKD EPI equations using creatinine, creatinine and Cystatin C and Cystatin C only at:  https://www.kidney.org/professionals/kdoqi/gfr_calculator

The most important aspect of these equation is that they are estimations and difficult to say they are “a gold standard”. We, as physicians, then use this information and along with the information that we get from performing a history and physician examination, we try to establish an estimate of your true kidney function.  

In order to diagnose chronic kidney disease (CKD), we also use urine testing for blood, protein and infection to also suggest the presence of CKD. 

Hence, if your muscle mass is above average for your age, then the serum creatinine may not be an accurate marker for eGFR. If you are taking creatine as a supplement, this also leads to an error in using the serum creatinine.

If your Cystatin C clearance or your 24 hour urine collection for creatinine clearance is normal, then it is unlikely that you have CKD. If your urine testing is normal,  then you do not have CKD with an eGFR of 62 milliliters per minute per 1.73 meters squared. 

Hi. Can chronic diarrhea be caused by Kidney Disease? Thanks for your time.

Diarrhea can be seen in patients with chronic kidney disease (CKD). It is not common but can be seen. Diarrhea may also be seen in patients with diabetes mellitus and there are also certain diseases of the bowel associated with diarrhea that can cause CKD.