Hi Dr Spry, my question pertains to my brother, who is 42. He has HTN consistently and decreased kidney function. He is going on a year if not more. He has seen a urologist but was told he needs to see a nephrologist. Problem is nobody has done anything to treat his HTN or the pain he gets in his flank area, so he refuses to see anyone else because these issues are not getting addressed. He did get 30 days of Lisinopril 20mg QD but won’t take it because it can cause him impotence. Of course, I explained there are other BP meds or meds to help with his other issue. So, with that being said, I would like to know how I can get him an appointment preferrably at your office, doesn’t matter who, sooner than later, to help get his BP under control and to monitor his kidney functions? I hate to ask another question but I have just found out my mom has decreased kidney function, Stage 3. Her last test showed 48%, which is up from last one, which I don’t know what is was. I have no idea if there is family hx of this or not, but not to my knowledge. My mom’s hx includes ETOH abuse, sober over 25yrs, tobacco use, has had her back fused and L)shoulder redone. She takes vitamins daily, low dose of Metotoprol 12.5mg, I believe, but she also takes alot of Tylenol and Ibuprofen and PRN Meloxicam. I look back and should have noticed some of her symptoms of the facial swelling, her H&H run consistenlty borderline or low and most recently fatigue. She is 71yrs old but very active, goes snow skiing, golfs all summer long, travels state to play in tournaments, does Zumba and walks so I thought all was good. I know that she will not do any type of dialysis, she just won’t. So given her kidney function was lower than 48% and came up to that, can it get better, can she get better? I know this is more than likely not acute and is chronic and I know that outcome but if she does choose not to do dialysis, what kind of time frame does she have? I know everyone is different as is every situation so hypothetically, what would you say? I appreciate your time and consideration with my questions. I always enjoyed you taking care of your patients!

In the case of your brother, I have always found that such people need to start trusting a physician.  The best place to start is with a primary care physician (PCP).  Your brother should find a PCP who he can establish with and build some confidence.  This may take some time, but this has to be the first step.  Once this is done, then the PCP may choose to refer to a nephrologist.  Direct referral to a nephrologist will likely not help the situation.  The important step with your brother is to trust someone to provide medical advice to him and then get consultation if needed.  The PCP is very much able to treat high blood pressure and treat early kidney disease.

For your mother, her use of non-steroidal anti-inflammatory drugs (NSAID’s) is very concerning.  The combination of Meloxicam with ibuprofen and Tylenol (acetaminophen) can be particularly damaging to the kidneys.  I am unable to provide a diagnosis or prognosis without performing a complete history and physical examination.  I would again suggest that your mother establish with a good PCP and follow his or her advice.

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