Does allopurinol prevent urinary tract infections by lowering uric acid? and what is commonly prescribed for urinary tract infections?

Allopurinol is a drug used to lower blood uric acid levels in order to prevent gout and decrease the likelihood of uric acid kidney stones.  It has nothing to do with urinary tract infections.  Antibiotics are commonly used to treat urinary tract infections.  There are many different antibiotics that are used to treat urinary tract infections (UTI’s) but the exact one depends on the bacteria that is causing the infection.

 

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Treatments, Urinary Tract Infection/Pyelonephritis

My father is 90 years old, was diagnosed with a kidney stone following a UTI which had him in the hospital for three nights. Now, a month later he is being scheduled for Shock Wave Lithotripsy. He is in very excellent health for his age with no cardiac or cancer history. What are the risks for someone his age?

A shock wave lithotripsy treatment is performed by a urologist.  I am a nephrologist.  I have no experience with lithotripsy.  This is a surgical treatment.  A urologist is a surgeon and you must ask the urologist who will be caring for your father about risks and benefits of treatment.  In most cases, it is my understanding that this is a relatively minor procedure but again, I have no experience with this surgical procedure.

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

Good morning doctor. My mother is suffering from acute kidney failure since 2012. In February this year she developed calciphylaxis in both her legs. Doctors here gave her pomonarate to localize the ulcer. It is healing but at a very slow rate. It is very painful. Now my concern is that she has calcification in her thighs, under her naval and near her left breast. Is there anyway to remove the calcium deposits from these areas? She is on Cinacalcite and Renagel…but is there anything other than that. The calcification is towards the upper layes of the skin. Awaiting your response.

Calciphylaxis of the skin is a relatively rare, very painful and serious complication of kidney failure and dialysis patients.  There are no standardized treatments that are universally recommended for this disease as it is so uncommon.  Surgical removal of the calcified plaques is not recommended and if done, usually results in worsening of the disease and more extension of the ulceration.  Many treatments have been tried including hyperbaric oxygen, sodium thiosulfate, and daily dialysis.  In patients with hyperparathyroidism, removal of the parathyroid glands (total parathyroidectomy) is commonly recommended.  If coumadin (warfarin) is being administered, this medication should be stopped.  Many of these patients must be treated in a specialized burn unit for specialized wound and skin care.

I recommend consultation with your mother’s nephrologist to explore options that might be available for her treatment.

 

Posted in Acute Kidney Injury, Ask the Doctor, Dialysis, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Medication and Kidney Function, Nephrologist, Symptoms and Side Effects, Treatments

I am a 75 year old male having lived in Mexico in retirement for the past 15 years. I have been a heavy, drinker of hard, straight alcohol for years but recently stopped alcohol usage completely on my own without the need for detox rehabilitation and any noticeable effects of previous significant alcohol consumption are no longer manifest. During the past two years I developed CKD and am fighting that disease with some success at preventing a downward trend for the past year but am uncertain as to where I am headed from here. I am not diabetic but have high blood pressure as I have had for at least 45 years controlled most recently over the past couple of years with daily doses of Micardis/Temisartan 40-80 MG. and hydrochlorizide 25 MG. or Furosemide 40 MG. The Furosemide when my high blood pressure becomes periodically problematic. I understand as a lay person that Micardis/Telmisartan is an ARB as opposed to an ACE Inhibitor. The Micardis remedy was prescribed to me by a doctor before my kidney problems arose. Should I continue with Micardis or Telmisartan or do you recommend I discuss an alternative with my nephrologist here in Guadalajara. Any recommendations as to what alternatives are worthy of exploration or do you recommend that I continue with Telmisartan?

I cannot prescribe medical treatment without performing a complete history and physical examination.  In this case, I suggest that you discuss your treatment with your nephrologist.  It is best to have someone who can examine you and provide on-going follow up of your blood pressure control and your kidney function.  The most important aspect of your treatment is to make sure that your blood pressure stays well controlled and average less than 130/80.

Posted in Ask the Doctor, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist

WHAT KIND OF CARE IS NEEDED FOR SOMEONE UNDERGOING DIALYSIS? MY BROTHER NEEDS DIALYSIS & IS CURRENTLY STAYING IN A RESIDENTIAL CARE HOME, WITH THE EMPHASIS ON RESIDENTIAL. THERE IS A NP THAT VISITS ONCE A WEEK. BUT THERE IS ACTUALLY NO NURSING CARE. DOES HE NEED A HOME THAT PROVIDES SKILLED NURSING CARE? MY BROTHERS WANT HIM PROPERLY CARED FOR. HE IS SENILE UNFORTUNATELY & WOULD NOT REALLY RECOGNIZE ANY SIGNS OR SYMPTOMS THAT WOULD NEED TO BE REPORTED.

I am unable to make a specific diagnosis based on the information that you present.  I suggest that your brother be evaluated by a nephrologist and determine to proper treatment that is required.  The level of care that your brother needs can only be accurately determined when he has a proper diagnosis and treatment plan recommended by a nephrologist.

For more information on dialysis click here:

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

Last year I was told I was borderline diabetic and my protein levels in kidneys were wrong, and that I had blood in my urine. The quick care urged me to see a Doctor. And of course I did not.. It’s been fourteen months and now I have a reoccurring rash just below where kidneys are. I urinate less and am constantly fatigued. I guess I am wondering if me freaking out right now is warranted and I really should see a Doctor? I had suffered extreme unexplained weight loss, dizziness and I’m worrying my eyes are getting worse so quickly.. I want to see a Doctor now but I’m scared. Is there a chance an easier explanation is possible?

I cannot make a specific diagnosis based on the information that you present.  I suggest that you see your physician and ask to be re-evaluated for kidney disease and have a complete history and physical examination in regard to your present symptoms.  You should see your physician.

 

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

As it is commonly known that proteinuria is a sign of kidney damage. I was reading some literature and it stated protein in the urine may or may not be present during the latter stages of renal failure such as stages 3,4 or 5. Why is this?

Protein in the urine (proteinuria) is seen in many forms of chronic kidney disease (CKD), but it usually suggests damage to the filters of the kidney (known as glomeruli).  Kidney diseases that cause damage to the glomeruli are known as glomerulonephritis.  Damage can occur in other areas, such as the tubules and inner parts of the kidneys known as the medullary interstitium.  These kidney diseases are known as interstitial kidney disease.  If damage occurs in these latter areas, proteinuria may not be seen as kidney damage progresses.  It is sometimes necessary to perform a kidney biopsy in order to know what areas of the kidney are being damaged in order to know how best to treat the patient with CKD.  Proteinuria is a common marker that is followed over time to assess the degree of damage that is occurring.  That is why we recommend that both the estimated glomerular filtration rate (eGFR) be measured and followed as well as the urine testing to look for the magnitude of proteinuria.

 

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

My husband has an annual check up every November. He is a 54 y/o, white male. This year his GFR was 53. There was some protein in his urine and his triglycerides were elevated >300. We were shocked! His M.D wanted to put him on B/P med. However, his B/P is running 124/72. I feel he needs further testing. What should we do?

Blood pressure medications are often used to treat patients with chronic kidney disease (CKD) who have protein in the urine (proteinuria).  This is often done when the blood pressure is normal.  I suggest that you and your husband discuss this with his physician and determine what is being treated and ask for measures to be taken that make a specific diagnosis as to the cause of the CKD and what are the goals of treatment.

 

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Medication and Kidney Disease, Medication and Kidney Function, Proteinuria, Risk factors, Symptoms and Side Effects, Treatments

Can a program of weight loss lead to a temporary, reversible decrease in GFR and are there any steps to minimize this? In Jan 2016 I was 1.75m tall and weighed 240 lbs. On the advice of my physician, I have followed a program of gradual sustained weight loss. I am still 1.75m but now 200 lbs. Over the same period my GFR has dropped from 84 to 65 ml/min. Could this change in my GFR be related to my weight loss program? and are there any protective steps I can take to minimize this. I am confident that the benefits of the weight loss outweigh(sic) any possible problems but if there is anything I can do to minimize the impact on my renal function whilst I continue to lose further weight towards my target of 170-180 lbs I would be happier. (average loss 1 lb/week, sustained over 10 months).

Diets and exercise that are designed to get you to an ideal body weight are in your best long term interest.  There may be some modest changes in your kidney function that may fluctuate from time to time.  It is difficult to know if these changes will be permanent or transient.  It is best to discuss your concerns with your physician, who is helping to supervise the weight loss program.  It is also best to continue to monitor these changes with both blood testing and urine testing looking for changes that may concern your physician.  The measurement of estimated glomerular filtration rate (eGFR) is less accurate when these measurements are greater than 60 milliliters per minute per 1.73 meters squared.  I suggest you discuss these measurements with your physician.

 

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

I have been diagnosed with stage 2 of CKD. Can you advise how harmful is a heart catherization to the kidneys if the test is required? My physician has considered recommending I have the test but I am afraid it will damage my kidneys.

I am unable to assess the risk of contrast for heart catheterization without performing a complete history and physical examination.  It is best if you express your concerns to the physicians who are caring for you and ask for consultation with your primary care physician (PCP) in making recommendations for the risk and benefits of performing a heart catheterization.  The risk is likely small but should be discussed with you before you make any final decisions.

 

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