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

Is diet protein intake a factor exacerbating CKD?

This is a controversial question. There is some evidence that a high protein diet can hasten the progression of chronic kidney disease (CKD). In the largest clinical trial sponsored by the National Institutes of Health, limiting protein intake did not result in a significant slowing of progression of CKD. Please see:  https://www.nejm.org/doi/full/10.1056/nejm199403313301301

However, there are smaller studies that suggest a potential benefit. My own recommendation to my patients is to avoid high protein diets and I generally recommend protein intake to be between 0.8 and 1.2 grams of high biological value protein per kilogram of lean body weight per day. The average Western diet is around 1.5 grams of protein intake per kilogram per day. Hence, this is a mild protein restriction. Advocates for protein restriction suggest that protein should be reduced to between 0.6 to 0.8 grams per kilogram per day and some even suggest much less (0.4 grams per kilogram per day) and supplement with amino acids. I do not advocate for this low of protein intake as I think it leads to protein malnutrition.  

Doctor, kidney transplant patient can not take NSAID medicine like Ibuprofen for muscle pain or inflammation. Is there any alternative medicine for us to take for muscle swelling, inflammation etc? What would you suggest to them for treatment?

I usually recommend topical pain medication for my transplant patients. Topical agents such as 1% Diclofenac Topical (also known as Votaren Gel) can be very helpful and do not have significant effects on kidneys. Salonpas topical pain patch is another useful treatment. Any topical pain medication that you can rub on your areas of pain should be safe for your kidney transplant. 

My Mother aged 62 years, suffering from Brain Stoke since February 2020, now yesterday in USG shown 3rd stage CKD. High blood pressure, sugar and electrolytes fractuation. Also swelling in upper limb. Please suggest what to do

I am not able to make a specific diagnosis based on the information that you present. I suggest that your mother consult with her physician about a specific diagnosis and treatment for her condition. Further testing will be necessary.  

Has there ever been a case where a kidney transplant patient could not lose weight while exercising and eating well? I recently reached my one year transplant anniversary and my new kidney is doing very well! I finally got my life back after doing PD for one year prior. Unfortunately, the only conflict that remains is the 40 pounds I have gained since. Before transplant, I was 122 and after waking up from the surgery I weighed 136. It has only gone up since despite staying consistent with a good diet and physical activity. I am now steady at 163. I have lost weight in the past without a problem and the weight gain was usually due to overeating. I can eat nothing all day and still gain weight. My doctors do not have an answer and I don’t think they believe I’m actually eating clean and exercising. It would be wonderful to get more insight on this and get down to a healthy weight.

There should be a dietitian that works with the transplant service and could help you design a meal plan, have you write down what you are eating and what exercise you are doing. It is true that some of the transplant medications can promote weight gain and keep you from losing some of the weight. I would have you contact your transplant coordinator and see if they can set you up with a dietitian to review your current status, review your current dietary intake and recommend changes. The dietitian can be quite helpful in helping gain insight into your current situation and guide you to a good weight loss strategy.  

I am aged 73, male Chinese. Two years ago, my creatinine was 115 mmol/liter and eGFR 54 suddenly. Over past 2 years, my egfr range 54 – 59, a few times above 60. So far no urine protein. My renal doc said I have CKD 3. I have controlled HTN for 25 years. My questions are: 1.) Must eGFR remain below 60 every time I do a renal panel test to confirm I have CKD? Must eGFR continue to be less than 60 for CKD patients? 2.) Must a diagnosis of CKD be made only if eGFR is below 60 plus proteinuria? 3.) I am taking probiotics (Renadyl) which are formulated to support kidney function and reduce progression. Are there evidence for such probiotics?

As someone enters Stage 3 chronic kidney disease (CKD), it is common for the serum creatinine to vary, sometimes yielding a estimated glomerular filtration rate (eGFR) of less than 60 milliliters per minute per 1.73 meters squared and sometime above. This is the natural variability of the testing procedure. Once the eGFR is consistently below 60, for greater than three months, then we do not need confirmatory testing of urine for blood, protein, or infection to designate CKD. If the eGFR is consistently above 60, then confirmatory urine testing is needed to validate the diagnosis of CKD. Sometime, this becomes a judgement call about whether this actually represents CKD.

I know of no information that Renadryl is effective for patients with chronic kidney disease (CKD).  

I am diagnosed Stage 2 Chronic Kidney disease. My two health insurances rejected me twice because of my chronic kidney disease plus my deafness. I am under extreme frustration that no one provided me proper resources with my chronic disease. Doctor kept telling me that I have to eat healthy foods, exercise and drink water. Not much else.

Stage 2 chronic kidney disease (CKD) is very early disease. It suggests that you have relatively normal estimated glomerular filtration rate (eGFR) but that you have blood, protein or infection in your urine for more than three months. You could also have polycystic kidney disease with an abnormal ultrasound examination or an abnormal kidney biopsy. 

Regardless of this, I’m not sure why you would be denied health insurance. Here in the United States, you cannot be denied health insurance on the basis of pre-existing conditions. I suggest that you review this with the Department of Insurance in your State.

Leukemia attached my kidneys and this was confirmed by 2 separate biopsies. I am in remission from leukemia for 2nd time. My nephrology doctor sees me every 3 months. I have advanced from stage 3 to stage 4. In all this time, she has never given me any suggestions to follow in way of exercise and or diet changes. Should I be looking for a new doctor?

Exercise is always good and the National Kidney Foundation and the American Heart Association both recommend 150 minutes of extra physical activity per week. As far as diet is concerned, a low salt diet of less than 2300 milligrams of sodium per day is recommended. Otherwise, diet needs to be specific for your level of kidney function and based on your laboratory findings. I recommend that you discuss diet with your nephrologist.  

I’m a stage four patient in full on panic mode. Are any traditional herbal kidney treatments beneficial? Also, where can one find an authoritative list of foods & supplements harmful to kidneys? What is the scientific verdict on cola soft drinks. I was an diet soft drink addict and finally quit, but I haven’t seen any improvement in my CKD.

I do not know of any herbal supplements that I would recommend. I do think that taking a supplement of calcium with Vitamin D can be a good thing as long as you do not have kidney stone disease. Somewhere around 600 milligrams of calcium and 1000 units of Vitamin D per day are appropriate.  

For patients with Stage 4 chronic kidney disease (CKD), it is best to ask your physician for a referral to a kidney dietitian that can review your laboratory testing and determine the foods you should avoid and recommend changes to your current diet. 

Dark colas and sodas contain more phosphorus that you should probably take with Stage 4 CKD and I would avoid those.  

The goal of treatment and diet is not to reverse CKD, as this is probably not a possible outcome. The goal is to delay further progression of your CKD.  

If I am on dialysis and have a fluid restriction of 32 oz, is it ok to workout/walk? I am obese and need to lose weight. So working out was suggested but I get thirsty. Am I allowed to drink more than the 32oz limit?

Absolutely. In hot and humid weather, fluid intake is often increased because of sweat losses. The way I explain it to my patients, 32 ounces is two pounds of weight. Between dialysis sessions, I don’t want them to gain more than 5% of your body weight. Hence, if you weigh 200 pounds, you should not gain more than 10 pounds between each dialysis session. The less weight that you gain between dialysis sessions, the better you feel after a dialysis session. Hence, if you can keep your weight gains to 3-4% of your body weight, this is better for you.

Each dialysis session, you should weigh yourself after dialysis and note that weight. At the start of the next dialysis session, you weigh yourself again and subtract your previous weight from the present one. That tells you how much water weight you have gained. If you are weighing in kilograms,1 kilogram is 2.2 pounds.  Hence, you can then figure out for yourself, how much fluid you can drink daily.  

I always encourage exercise and activity in my dialysis patients, but drinking for the sake of drinking is not a good idea. Avoid drinking ice water and avoid drinking Sport Drinks because they contain more salt than you need. Drink just plain water, without any additives. Good luck with your exercise program.  

What medications for acid reflux and gastritis are safe for stage 4 kidney patients?

Any of the Proton Pump Inhibitors (PPI’s) and some of the H2 blockers are safe. However, it is important to ask your primary care physician (PCP) about use of any of these drugs, especially if you are taking other medications, as these drugs can have an impact on other drugs that you may be taking. These need to be reviewed by your PCP to make sure they are safe for you.