Doc, Three years ago I had kidney failure. My creatinine level was 10. I had no pain or illness, just out of my mind. Kidney Doc determined use of NSAIDs, Aleve, metformin, lisinopril made a perfect storm. Since, my creatinine levels have remained 1.0-1.04. No higher. I’m a 58 yo male, 5’9” 150 pounds. I’ve haven’t taken anything NSAIDs, metformin, and only 5mg lisinopril daily. I’m Type 2 diabetic. I have to take morphine sulfate 15mg x 3 and 10mg Oxycodone x 2 daily for chronic pain due to combat injuries. My kidney doc stated he moved me to stage 2 two years ago only because he couldn’t just move me from 3 to 1 automatically. Can I be considered cured? I long to drink a cold beer on a hot day.

After an episode of acute kidney injury, there is often residual kidney damage that has been done. I cannot determine if your kidney function is back to normal based on the information that you present. I suggest that you continue to have regular checks of your serum creatinine, estimated glomerular filtration rate (eGFR) and urine testing for blood, protein and infection. I also suggest you continue to follow with your physician as you have Type 2 diabetes mellitus. Type 2 diabetes is a common cause of chronic kidney disease (CKD).  

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Posted in Acute Kidney Injury, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diabetes, GFR, Kidney-Related Health Questions, Serum Creatinine

My 27 year old son is in kidney crisis with a creatinine tonight of a 10.4 and rising. He is on a kidney diet and is still urinating. He has been otherwise healthy until last week and is currently puzzling the medical community. When would you start dialysis?

I am unable to comment on treatment without performing a complete history and physical examination. The decision to start dialysis must be made by the physicians who are evaluating your son. There are specific indications for starting dialysis but the serum creatinine that you quote is quite high and suggest very little kidney function.

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Serum Creatinine

Good day. I have a kidney stone, very large in my left kidney. It’s only functioning 5 % and right kidney 95%. One doctor says to remove left kidney totally to save me trouble down the line. Next doctor says no I can live with the stone cause of it being large. I must have had it over 15 years. Not suffering until last year. I will be 60 yrs old in 3 months and suffer from high blood pressure / ptsd / hep C / medication taking is Prozac, Trazadone, Amlodipine/Ben 10/20. As of May 2 the urologist who wants to remove kidney treated me for infection and placed a stent in urethra. Please help me to do right choice. I had 5 surgery’s in past for child birth reasons. I don’t want to go under the knife again. Thank You

I am a nephrologist and as such I have no expertise in surgery. A urologist is a surgeon. The question that you ask is a urological question and I have no expertise in this area. Since you have two different opinions, you may want to consult with your primary care physician (PCP) and ask him or her to help you make a decision.

Posted in Ask the Doctor, Kidney-Related Health Questions, Nephrologist, Urological Issues

Hello doctor. My mother has stage 5 chronic glumerulonephritis.She was advised to have a dialysis. Due to high creatinine level , she was inserted with IJ catheter in her neck for her dialysis treatment. Her dialysis treatment was only twice a week and it started last June 2018 . But still she suffered a lot of pain in her back and stomach. She has also dry cough that unable her to sleep especially at night times. She has also difficulty in breathing and unable to urinate. During dialysis, she has high fever and even chill. After dialysis her body temperature goes back to normal. Is this normal in her case? Or is she not receiving a good care? What shall we do? Thank you doctor.

I cannot make a specific diagnosis based on the information that you present. Your mother’s response to dialysis does not seem to be going very well.  These are not the kind of responses we expect with dialysis. I suggest that you schedule a consultation with her nephrologist to determine any problems that she may be encountering.  I suggest that you address your concerns with her nephrologist.

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

My lab results include a total stdKT/V. This includes the following components: spKdt/V, eKdt/V, Krt/V, spKt/V, stdKdT/V, stdKrT/V. Please define these components for me. Thank you.

The abbreviations that you mention are various ways of describing the efficiency of your dialysis treatments. These results describe the expected degree of clearance of urea from your body during a single dialysis session. The equations are very sophisticated math and involve something called “urea kinetic modeling”.  A KT/V is the most simple way of expressing the clearance which uses the blood concentration of urea as you start dialysis and the blood concentration of urea at the very end of your dialysis session. These values along with the number of sessions of dialysis per week, duration of your dialysis session, the amount of water that is removed, your weight and your sex are all plugged in to the equation to get different results. The Standardized KT/V (stdKT/V) is the traditional way of describing your degree of dialysis cleansing as measured by the clearance of urea from the blood. If your blood tests also includes a 24 hour urine for urea clearance, then you can also calculate the residual kidney function that your remaining kidneys have with the KrT/V. The single pool urea clearance uses a different calculation that estimates the clearance of urea as if it is in a single pool of fluid (spKdT/V & spKt/V). If the blood is drawn some time after your dialysis so that the urea concentration is equilibrated, then a equilibrated KT/V can be calculated (eKdT/V).  Each calculation uses different assumptions.  The “r” stand for residual kidney function and the “d” stands for dialysis session. Your nephrologist can look at each of these equations to devise a way to change your prescription in order to achieve an adequate dialysis treatment.

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Laboratory Testing, Nephrologist

I am a 45 yr old female, non-smoker, with Postural Orthostatic Tachycardia Syndrome (POTS) and ADHD. Recent blood tests from my neurologist indicated rising creatinine (0.8 to 1.05 over past 14 months) and decreasing eGFR (91 to 64 same time period). Looks suspicious to me, but I take florinef (plus 8-10 g salt and 4 L water) and clonidine for POTS (and buproprion and strattera for ADHD). Do you know if the POTS treatment could artificially change the creatinine and eGFR results in the absence of actual kidney disease?

I am unable to make a specific diagnosis based on the information that you present. I am not aware of any information about the use of the medications that you mention having any direct effect on kidney function tests. The estimated glomerular filtration rate (eGFR) that you mention remains above 60 milliliters per minute per 1.73 meters squared.  An eGFR greater than 60 is considered normal, so I am unable to make a diagnosis of kidney disease based on the information that you describe.

Posted in Ask the Doctor, GFR, Kidney-Related Health Questions

Hi! I have ckd end stage and having hemodialysis treatment for 17 years. Have you known about the herbal juice called INTRA from Canada? Can this Intra are good to us patient with ckd and can my kidney be heal on this juice?

I am not familiar with any juice or product that will return kidney function to someone who is on dialysis. I have never heard of INTRA and would suspect that this is a scam meant to part you with your money.

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions

Dear Dr, Could you please explain this diagnosis for my wife. It is complex renal cyst of size 23 x 21 mm noted in the upper pole with thick septations.

From your description, it is likely that this is a finding on an ultrasound examination. This is a relatively small cyst of the kidney but it is not a simple round cyst because it contains internal echos that may be tissue separations. I am unable to make any other specific diagnosis based on this information.  It is usually recommended that a repeat ultrasound examination be done on this cyst in 6 to 12 months in order to determine if this cyst grows with time. It is best to consult with a urologist in regards to diagnosis and treatment of this cyst.

Posted in Ask the Doctor, Kidney-Related Health Questions

I am a mother of a son with kidney disease. He is at Stage 3. His GFR is 30 – 59. Blood Pressure ranges between 120/70 and 130/80 and is on medication Nabathothol (hope spelling is accurate enough). He takes 2 in morning and 2 at night. My question is what risk (he also need hip replacement) is there in getting this surgery in relation to his kidney problem? Will anesthesia given him cause and danger or risk to create a reaction to the kidney disease? Where can I go to get some help and support to become more knowledgeable of his condition. He is incarcerated and in a different state. The distance does not allow me to visit him too often.

I am not familiar with the drug “Nabathothol”. I am unable to make any specific diagnosis based on the information that you present. I am unable to comment on any risks or prognosis for your son without performing a complete history and physical examination.  In order to seek help, you will need the name of the exact and specific diagnosis related to your son’s chronic kidney disease (CKD).

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Medication and Kidney Disease

Why is my gfr and creatinine fluctuating? Was 20 and creatinine was 2.43. Now get 36 creatinine 1.73. Has been fluctuation for 2 years. Are my kidneys going to get worse?

I am unable to make a specific diagnosis based on the information that you present.  I cannot explain why your kidney function is showing so many changes and fluctuations. I suggest that you consult with your physician regarding your concerns.

Posted in Ask the Doctor, Kidney-Related Health Questions