I have been told by two experienced specialists that I should be seeing a Nephrologist. My GFRs have been under 60 for well over 5 years although it is up some now at 58. The only two times I have had urine test to determine if albumin is in the urine showed such. The last was 3.7mg/DL in 8/16 and the previous one was 9.1 in 1/15. All of my cholesterol numbers are off, especially triglycerides. I take medications for that and diet. It still doesn’t bring the totals to normal limits. Serum creatinine is WNL but occasionally strays out of range. I keep reading about the ACR but I don’t think its ever been done for me. My SED rates are always off indicating in general inflammation, I believe. My overall health is poor and I have over 20 diagnoses, most are chronic and severe. I believe that I may well have an autoimmune disease but my doctors really don’t want to thoroughly check this. I bullied my way into getting another Rheumatologist to look at me, hopefully soon. I don’t know if I have an autoimmune disease but I sure have a lot of symptoms indicating it. If it isn’t autoimmune it is certainly neurological. I have diagnoses including Fibromyalgia, Chronic Severe Pain, Chronic Fatigue, severe lung disease, thyroid disease, heart disease, diabetes, high blood pressure, some form of neuromuscular disorder, and on and on. I have been told by at least 3 doctors that I have CKD – stage 3A which I understand is moderate. But given all the other issues, shouldn’t I be seeing a Nephrologist if only to attempt to find an underlying cause or determine if my kidneys are causing many of problems or are they the result of other issues. My doctors don’t seem to care. I have never had an ultrasound to check my kidneys. I would think even a GP would have done that. I am sick of having to become my own doctor because my doctors don’t seem to want to be bothered. They say — ‘let’s treat the symptoms and forget about the underlying causes.’ Of course treating the symptoms may well be masking underlying causes that might have treatments that could be implemented. I have no goals to set records for longevity (I am 64) but I would like a crack at having some quality of life. Health care here in northern Indiana is awful. Can you give me your opinion and some advice?

I do not identify a chronic kidney disease (CKD) based on the information that you present.  You have at least three risk factors for CKD including diabetes, high blood pressure and heart disease, so it is certainly possible that one or any of those problems would lead to early Stage 3a CKD.  If you have not done an albumin to creatinine ratio (ACR) previously, then I suggest that you have one done as part of your evaluation of diabetes and high blood pressure.  If you have protein in your urine, then you should be treated with an ACE inhibitor or an ARB agent for control of your high blood pressure.  Your blood pressure should be controlled to less than 130/80 and your diabetes should be controlled and target a hemoglobin A1c (HgbA1c) between 6.0 and 7.0%.  You should follow a low salt diet, perform extra activity for at least 150 minutes per week, and maintain a healthy body weight with a healthy diet and exercise.

 

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