My husband has been hospitalized for a week. I took him to the hospital due to extreme blood pressure 220/120 and his blood tests showed a creatinine of 3.3. Since that day, his creatinine has risen steadily to a high of 4.2.  When he hit 4.2, the kidney specialist put him on fluids, which resulted in a level of 3.9. The doctor then tested him the next day and it rose to 4 again. He was to be released today, but the doctor gave him more fluids and tested him again and his level rose to 4.1.    We are obviously very concerned. The doctor has done everything from taking him off ace inhibitors and diuretics, started and stopped steroids, and placing him on a renal diet. His blood pressure has lowered significantly to normal but his glucose has been high, between 150 and 266. He is spilling about 3 grams of protein. My question is can his creatinine improve at this point? Is it common to see a rise like this that eventually goes back down? Is there anything else he can do? FYI, my husband is diabetic with high blood pressure, ckd stage 4 and obstructive sleep apnea. He is 33 years old.  

High blood pressure injury to the kidney can be reversed but I have seen it take several months of very good control of high blood pressure and diabetes to see an improvement.  In this case, the only thing you can do is follow the advice of your doctors and carefully control his blood pressure, eat well, and keep his diabetes carefully controlled.  Damage done by diabetes, however, is not commonly reversed.

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Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Hypertension/High Blood Pressure

I am on my second kidney transplant (first in 2002, second in 2011.) The primary illness that caused kidney problems was Lupus which is now under control. Lately, I have learned about a new supplement produced by LPGN, called Laminine. I have done some research on the Internet and have found a lot of people with different illnesses for whom this product was helpful. The company LPGN says Laminine can help to rebuild kidney cells. I wonder if I can take this product without negative consequences like: interactions with immunosuppressive drugs (Cyclaid, CellCept), or strengthening my immune system. I would be grateful for the answer.

The substance known as Laminine appears to be a supplement produced without any scientific research being done on kidney patients or transplant patients.  There are no studies to examine interactions with medications.  For kidney transplant patients, I do not recommend herbal supplements because we do not have any information about what they may do to your kidney transplant and we have no idea how they might change the levels and actions of your transplant immunosuppressive drugs.

Posted in Ask the Doctor, Herbal Supplements in Kidney Disease/Failure, Transplantation

My first question concerns page 13 of the booklet I was sent it warns about Phosphorus in Beer. As nobody seems the slightest bit interested in having Phosphorus added to the ingredient label we bought the book Bowes and Churches’ food value to try and eat/drink well. Also, we have a Nephrologist and a dietitian for help. In the book, however, beer is quite good so this does not seem to be the case at all as Phosphorous is shown for beer as no more than 50 mg per 12 ounces? Much better than many other food products. My second question is why is it that the FDA has no interest in this subject? With some 26 millions people with CKD surely they should have an interest. I have not been able to get a positive reply by phone or email. What is your organization doing to try to focus attention to this problem? Most food suppliers I have written to either do not respond or say words to the effect “if FDA does nor care why should we”.  Some have referred to the lack of pressure from NKF as proof it is not important. I hope for a reply that is helpful.  

The best reference for the phosphorus content and other nutrient contents of food including beer can be found on the USDA nutrient data base which can be accessed at: http://ndb.nal.usda.gov/ndb/search/list  You can type in the food or beverage that you want and it give authoritative information.

The National Kidney Foundation has long recognized the problem with phosphorus content of foods.  You can visit our web site and see the numerous articles written about phosphorus in foods.  Please see:  https://www.kidney.org/search-results?solr-keywords=phosphorus+content+of+food

I also wrote a Huffington Post blog about the problem of phosphorus content of foods in November 2013.  Please see that blog post at:   http://www.huffingtonpost.com/leslie-spry-md-facp/holidays-health_b_4338943.html

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition

I am a 38 year old woman, Type 1 diabetic since 2002. I have very poor control (had eating disorder since 1997). Now in Stage 4 kidney disease. My function 17% and dropping rapidly was 35 in November. I have high bp, severe anemia, unable to walk very far without getting severely breathless. Chest X-ray showed up fluid on lungs. I get really bad swelling in my legs and feet and am undergoing all the tests pre-transplant. I have had severe pain in my right side for 3 days now it is in my side, lower back and drifts into my abdomen on that side. It feels very deep, very much like a stitch but much more painful. So much pain that I can’t get comfortable. I dare not take pain relief without seeing my nephrologist first. Whom I’m due to see on the 21st of May but I can’t stand this pain. I’m scared and don’t no what to do. I am scared that I’m going to die.

I am unable to make a specific diagnosis based on the information that you provide.  The pain that you describe may represent excess fluid and you may need to consider dialysis treatments.  If your pain is persistent, you should consider being evaluated sooner by your physician or go to the emergency room.

Posted in Ask the Doctor, Chronic Kidney Disease, Symptoms and Side Effects

Doctor my son was born week ago with one kidney and his working kidney creatinine levels are in the 2.0’s. They are fluctuating up and down in the NICU. How should we be feeding him and what concerns should we have when he comes home?

I am an adult nephrologist and do not see children.  I suggest you continue to consult with the doctors caring for your son.  I have no expertise in this situation.

Posted in Ask the Doctor, Birth Defects/Urinary Tract Abnormalities, Chronic Kidney Disease, Pediatric Issues

I have a serious back pain which radiates from left to right two – three month ago. I went and see a doctor for several times. I was referred to do ultrasound wave check and I did. Not any change in size or shape. Also, I did urinalysis test with negative result, then and now. I still feel the pain but not as it was prior with little changes from back to internal ache. At times from lower abdomen to bladder most especially my left side, the pain is more severe than the right.

I do not identify kidney disease based on the information that you present.  Pain is an uncommon presentation for chronic kidney disease (CKD).  If your blood testing, urine testing and ultrasound are all normal, then this is not kidney disease.

Posted in Ask the Doctor, Symptoms and Side Effects

I have been diagnosed with Acute Kidney Disease by my PCP. What is this & how does it differ from Chronic Kidney Disease?

Acute kidney injury (AKI) (Acute kidney disease) means that there has been a sudden and unexpected decrease in your kidney function.  This commonly occurs over several days.  Acute kidney injury may be reversible, if treated promptly. You can read about AKI at:  https://www.kidney.org/atoz/content/AcuteKidneyInjury

In contrast, Chronic Kidney Disease (CKD) is a slow and usually steady deterioration of your kidney function over several months to years.  Once CKD has shown progression, it is commonly not reversible.  You can read about CKD at:  https://www.kidney.org/kidneydisease/aboutckd

Posted in Acute Kidney Injury, Ask the Doctor, Chronic Kidney Disease

I have diabetes, with very tight blood control. For a month, a pain in back has increased from what I thought was a muscle pull to seeing my PCP last week, with suspected kidney issue. During the past week, I’ve had an ultrasound, CT scan and now waiting on renal and urine culture. Initial findings: hydronephrosis. Please suggest if I should see a kidney specialist or a urologist first? and how long you think is appropriate to wait to see the specialist? The first kidney specialist I called today told me they couldn’t see me for 2 months. I don’t think the pain will wait that long.

If this is hydronephrosis, then you need to see a Urologist and depending on how much pain you are in, I would suggest that you see him or her within a couple of weeks. If severe pain, then should be seen sooner.  I am a nephrologist, and I would not be able to help you until you were seen by a urologist in order to relieve the blockage of your kidney (hydronephrosis).

Posted in Ask the Doctor, Hydronephrosis and Hydroureter, Urological Issues

My niece is 5y/o. Just diagnosed with Nephrotic syndrome, non reactive kidneys. She has been put on steroids. Her father has been told the steroids may take up to two weeks to see if they work. No family history of kidney problems. She’s had off and on short stomach pains and a cold since Dec. How can I get more info?

Your niece sounds like she has Childhood Nephrotic Syndrome.  The only way to be sure of a specific diagnosis is to perform a kidney biopsy but this is not commonly done unless a child does not respond to the steroids.  You can review a summary of this disease on our web site at: https://www.kidney.org/atoz/content/childns

Posted in Ask the Doctor, Nephrotic Syndrome, Pediatric Issues

Will my 87 year old grandma be able to care for herself or will she need care in the future? Her GFR is 29. She also has to be on a low sodium & potassium diet but she just started eating high sodium & potassium foods three weeks ago. So if she gets blood work now will it show an increase in her potassium level or would getting blood work a month from now show an increase? I would like to prove her diet could be hurting her.

I have no way to offer a prognosis without examining your grandmother.  I am unable to provide a specific diagnosis or specific prognosis based on the information that you provide.  You will have to rely on the advice of the physician who is caring for your grandmother.

For general information about diet and CKD please click here.

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition