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

Hi Doctor, my 16 year old daughter just finished up intense treatment for lupus nephritis and her kidneys appear to have responded very well. She is currently taking a lot of supplements for her lupus but I am worried that it may be too much for her kidneys. I asked our nephrologist about this and she said that while there is no evidence saying this would be harmful, there is also no data to say it may be safe. She is taking a multivitamin, Vitamin C, Vitamin D3 + K2, Iron, and molybdenum. Any insight you may have is greatly appreciated! Kindly.

I would agree with her nephrologist. The multivitamin, the Vitamin C, the iron and the Vitamin D are commonly regarded by the Food and Drug Administration (FDA) as Generally Recoginized as Safe (GRAS) meaning that most people should not experience illness as a consequence of taking over the counter supplements. Anything else has likely not been tested and does not have the historical experience to be GRAS. Hence, it is hard to say something is safe in all situations.  

My cousin in the Dallas area is over 50, and has been seeing the same doctor for his kidney issues for years with no relief. Yesterday, he had some kidney stones removed. But he suffers from pain and blood in the urine on a regular basis. Who can we talk to, or where can we get help to advocate for him and his medical condition?

I would recommend that your cousin visit with his primary care physician (PCP) where he lives and ask for a referral regarding recurrent kidney stone disease. His PCP is going to be the best resource for such a referral. A urologist would treat kidney stone disease, but it is more common for a nephrologist to evaluate and treat in order to prevent future kidney stones. Neither I nor the National Kidney Foundation provide referrals for care.    

My blood tests for eGFR over the past two and one-half years have gone from 76 down to 53. That’s 23 points. I am 69 years old. I exercise and run each day, never smoked, have a glass of wine twice a month, weigh 123 pounds and just found out I have SVT. Can I do anything to bring my eGFR back up? I am scheduled to see a Nephrologist. Thank you.

I am unable to make a specific diagnosis based on the information that you present. In order to complete screening for kidney disease, I recommend that you have urine testing for blood, protein and infection. This will help to determine whether there is any confirmatory evidence for chronic kidney disease (CKD) other than the decrease in the estimated glomerular filtration rate (eGFR). In the absence of a specific diagnosis, I am unable to recommend any treatment. It sounds like you lead a very healthy lifestyle, so I am not sure there is anything you change in your life right now.  

Is there anything you can do about frequent urination at night?

It is necessary to make a specific diagnosis in regards to frequent urination. Frequent urination in a male versus a female is caused by different problems. Issues related to the bladder and prostate are most common causes and are usually evaluated by a urologist. Kidney causes of urinary frequency include diabetes mellitus, diabetes insipidus, sickle cell disease, and diuretics.  

I have two GFR numbers Black 61 and Other 50. Why the 11 ML difference? What can I do to raise them? I am a 69 year old Black female.

So it turns out that some of our equations use race as a relevant variable in estimating the glomerular filtration rate (eGFR). The National Kidney Foundation has been very involved in addressing this issue. On average, a Black person of the same age and the same body weight as a white person will have a higher eGFR than the white person, but this is not always the case. You can learn more about this on our web site at: https://www.kidney.org/newsletter/changes-to-egfr-calculation-and-what-means-people-living-kidney-disease

Hence, when we use one of those race variables in your calculation, it comes up higher by 11 than it does if you were other than of the Black race.  

Management of your kidney disease should be addressed by your physician. It is important that you not smoke, follow a healthy low salt diet, exercise regularly and maintain a healthy body weight. You should monitor your blood pressure and keep your blood pressure under 130/80 and you should carefully manage your diabetes, if you have diabetes. You should avoid non-steroidal anti-inflammatory drugs (NSAID’s) such as Motrin, Ibuprofen, Advil, Aleve and Naproxen. Any other treatment must be managed by your physician.

Is there another treatment for a 55 year old with AIN/AKI other than oral steroids? No known allergen or cause has been identified. Elimination of all medications/supplements. Creatinine and BUN remain elevated.

The conventional treatment for Acute Kidney Injury with Allergic Interstitial Nephritis (AKI/AIN) is usually Prednisone (steroids) in order to hasten the recovery. AIN commonly recovers with time but it can take many months to do so. I am not aware of any other treatment that has been used for this particular kidney disease that is usually diagnosed on kidney biopsy.  

Recently, I experienced excruciating needle-like pain from the urethra which felt like the stinging of a hornet as well as intense pain on right side that I could barely walk along with nausea as well. I took a Tylenol and have been feeling fine so far. I had UTI last year at the same time. I know I have to eliminate salty, potassium and phosphorus foods. I also have small stones that have been there for a long time after having a CT scan but was told by a doctor not to worry about them but I do as a senior.

I am unable to make a specific diagnosis based on the information that you present. The passage of small kidney or bladder stones can cause the discomfort that you mention but without doing further testing and examination, I am unable to make a definitive diagnosis.

Hi Dr., Appreciate if you can share your prognosis for the below report. And also if in this case, catheterization can be done for hemodialysis? PFB the report: CT ANGIO PERIPHERAL BOTH UPPER LIMB VENOGRAPHY CT study has been performed on a 128 slice CT scanner following IV injection of non-ionic contrast (100 ml @ 4.5 ml/sec), using bolus track software to time the optimal contrast opacification phase. Findings: The study reveals diffusely irregular walls of the superior venacava seen with areas of dilatation and narrowing and a small eccentric organized thrombus along the medial aspect of the SVC. There is significant stenosis of a long segment of proximal part of right internal jugular vein seen with IJV measuring 2mm in diameter in narrowest part. The left internal jugular vein is not seen in the proximal part — s/o occlusion. There is good reformation of distal parts of bilateral internal jugular veins seen near the base of skull via collaterals. The right external jugular vein is dilated. There is severe stenosis of proximal part of left external jugular vein also seen. The left innominate vein is also diffusely narrowed in calibre measuring approx 4mm in diameter. Multiple venous collaterals are seen along the neck and upper chest wall region. The visualized parts of bilateral subclavian veins, axillary veins and brachial veins appear normal in course and calibre with good luminal contrast opacification. The visualized parts of bilateral cephalic and basilic veins are relatively diffusely narrowed in calibre with relatively poor luminal contrast opacification, however, no obvious thrombosis of these veins is seen. Thanks in advance for your time and help.

This study is a computerized tomogram (CT) evaluation of the veins of the neck and upper extremities using contrast. It suggests that there has been narrowing and a blood clot in the main upper vein of the chest (superior vena cava) and also narrowing of both main veins in the neck (internal jugular veins). This suggests that there has been previous catheters placed in these areas that have caused damage to these vessels. I am not a vascular surgeon and could not comment on whether catheters could again be placed in these areas.You would need to consult a vascular surgeon or interventional radiologist about whether these veins could be used for vascular access for hemodialysis therapy.  

Hello. I had bloodwork done in preparation for a yearly physical. BUN is 27; BUN/Creatinine Ratio is 36.0. I’ve noticed some bubbles when I urinate. Should I be concerned?

Bubbles in the urine can be normal or they can indicate too much protein in the urine. I suggest that you have a screening urinalysis done as well to look for blood, protein and infection in the urine. An elevated Blood Urea Nitrogen (BUN) to creatinine ratio is often seen with dehydration. If your urinalysis is normal, then this is likely not anything to be concerned about.  

Sir, my new born baby is 28 days old and is showing moderate hydronephrosis. Please share any suggestions with me?

I am an adult nephrologist and I have no expertise regarding infants and children. In this situation, you should consult with a pediatric urologist regarding hydronephrosis in an infant.