Daily Archives: January 10, 2017

I am a 39 yr old African American with stage 4 chronic kidney disease, fsgs, currently no swelling but bad appetite, difficult concentrating, GFR 35, creatinine serum 1.78, creatinine ratio 91.9 and vitamin D 14. My question is should I be on dialysis and is 1200 mg of sodium bicarbonate the only medicine I should be taking?

Dialysis is not indicated for someone with an estimated glomerular filtration rate (eGFR) of 35 milliliters per minute per 1.73 meters squared.  Dialysis is often considered when the eGFR is less than 15.  Sodium bicarbonate is used to correct acid … Continue reading

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

Hello, My husband consumes around 3 liters (or more) of diet cola per day, every single day, to the exclusion of all other drinks. I know this has to be harmful to his kidneys but I don’t know exactly how to convey that to him. Can you explain what this kind of thing could do to his health? Thank you.

Intake of soda pop of all kinds has been associated with obesity and weight gain.  This includes intake of diet sodas and colas.  Colas in particular have a large amount of phosphorus (that makes the color dark) and this is … Continue reading

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

My father age 72 at the time, fell and broke his knee. He is on Coumadin due to a DVT in 2002, in which Lovenox led to compartment syndrome and faciotomy. He was given Lovenox and had retroperitoneal bleed, paralyzed his right leg. GFR was 30 at the highest, more in the teens and 20’s. He has a baseline creatinine of 2.4, and is borderline being sent for dialysis. What are the recommendations for Lovenox and kidney failure….stage 3, solitary kidney?

The dose of Lovenox (enoxaparin) must be reduced in patients with chronic kidney disease (CKD).  I have observed a greater risk of bleeding in patients with CKD when using anti-coagulants of all kinds including Lovenox.  This risk is greater than … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Dialysis, GFR, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Treatments

l am considering an MRI to determine the cause of my lower back pain. My eGFR is usually around 50. You have often warned about having contrast dye injected in connection with this procedure. I wonder if there might be an alternative contrast agent with which you are familiar? If not does a single application lead to significant kidney damage?

A magnetic resonance imaging (MRI) scan used contact agents such as gadolinium, which is safe for kidney patients with an estimated glomerular filtration rate (eGFR) of 50 milliliters per minute per 1.73 meters squared.  I recommend avoiding MRI contrast agents … Continue reading

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

My 16 yr old very athletic son suddenly developed HTN 5 weeks ago, along with pulse in 90’s-114 at rest. This was accompanied with intermittent upper mid abdominal pain. After evaluation by a cardiologist, gastro and nephrologist, nothing determined as the cause. His labs showed high Hgb and a 24 hr urine collection showed creatinine of 3402 mg/dl, as well as high norepinephrine and low dopamine. He still has the abdominal pain even though he has been taking a blood pressure med for 3 nights now. He only had 1000ml of urine in 24 hrs (because we had to dump the first specimen) but this does not seem like enough for a 5’11” 180 lbs guy. He does not feel the need to urinate when he wakes up in the morning. I’m scared he has a kidney problem. What tests should be done?

I suggest further testing for an endocrine cause of the hypertension.  Your son may need to be seen by an endocrinologist.   I would also make sure that he is not taking any body building supplements that might cause these … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Pediatric Issues, Pregnancy / Kids, Symptoms and Side Effects, Treatments

My father is a new dialysis patient – only 1 month in. He is 77, diabetic, suffers from peaks of high blood pressure and is now on dialysis. It has been a very hard transition for him to make. His fistula failed so an emergency port was placed in his chest. He has had surgery just this week to implant a fistula graft in his arm. He is currently residing in a rehab facility in a nursing home. I’m sending this because I feel like I cannot get answers from local doctors and treatment facility. This last Monday was the first time his dialysis team was able to get his dialysis up to 400 (Fresenius facility). On Tuesday morning he called me at 6:00am in a panic. He felt like he was having a low blood sugar with sweating and confusion. He was seeing things that weren’t there. His BG was 245 which isn’t that odd for him, so that was ruled out. The nursing home was sure he was going to pass out and were ready to send him to the ER. After he ate and drank something, it started to pass and by evening he was back to his normal self. He was VERY angry at the Monday treatment and so we figured it was a manifestation of his mood. My other instinct is his electrolytes were out of balance. I’ve taken care of my dad for the last four years and in the past when he would get in a similar mood, a gatorade or juice helped ease the confusion. I know gatorade is not good due to the high levels of all the things a dialysis patient shouldn’t have. But he acted like that was what he needed. It got better as the morning went, so everyone moved on. Wednesday night, dialysis again. He was in a much better emotional place than the previous treatment. However, at 4:00am the next morning, he had the same issue. Confusion, seeing things that weren’t there, worry, anxiety. He described it like a nightmare. Then after a meal and a few hours it passed. The nursing home staff have no answers except to refer him for an eval with a psych doctor. We cannot find anything online on any kidney or dialysis sites that relates to dysphoria (nurses said it was a type of dysphoria he was displaying.) The only link to what my dad is experiencing and information is related to dialysis disequilibrium syndrome and all research I’ve found says that is not a common condition anymore with modern treatments. He acts like he’s anemic and his electrolytes are out of balance. We keep getting told that blood tests are done once a month and that would be able to tell us more. The nursing home staff really aren’t doing much to find a solution. The nephrologist NP he sees is out of town till the end of next week. The staff at the dialysis center say its not related. Nothing really online. I’m scared and no one will talk to us about this problem and just want to send us off to someone else. Dialysis wasn’t even on our radar. We knew it might be something in the future but my dads kidney function has maintained for two years between 15 and 20%. No training. No counseling. Nothing. Then he goes to the hospital with what we thought was a heart attack. Very aggressive blood pressure treatment took his kidney function from 14% to 6% in three days. It wasn’t until the third day that his other blood indicators said yes, his kidneys were failing. And, he didn’t have a heart attack. The week leading up to his first treatment, he swore he would not do it no matter the end result. The next morning, he was OK with it, had the emergency port put in and had dialysis three hours later. Now, one month later we are only a little wiser about dialysis and only because we sit with him for each treatment and ask questions of the nurses. Since this dementia behavior has surfaced, we know even less. No one will give us a straight answer, check his blood, do any scans, something…anything that can give us a clear idea of what is going on. My father has a PhD in Mechanical Engineering. My mother was an RN. Four of the eight children and husbands in our family are educators. We are intelligent people seeking intelligent answers. Reaching out to you is a long shot I know, but it is all I know how to do right now. Any advice. Any thoughts. Any history. Any suggestions are greatly appreciated.

Every month, the dialysis team gets together for something called a multidisciplinary conference to discuss the patients in the dialysis unit.  I suggest that you talk with the social worker who is responsible for your father and ask to be … Continue reading

Posted in Ask the Doctor, Diabetes, Dialysis, Hypertension/High Blood Pressure, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

I am currently on dialysis three times a week. I have only one kidney as one was taken out due to a botched hysterectomy. My kidney failure is due to antibiotics used in treating hospital acquired pseudonomas bacteria pneumonia. I have been on dialysis for 5 years now. Ever since the first day that I started I have to stop the machine or sign out early because I cannot hold my urine any longer. This is getting to be very aggravating. I also have had numerous UTI’s as holding my urine for sometimes 2 hours gives me a bladder infection. My blood work for potassium and phosphorus are good on the high end of the last level before it is high. I read on a paper today that the only way phosphorus leaves the body is through a functioning kidney or through your binders. I have never taken binders as they hurt my stomach and cause worse constipation. My question is Could I safely have my time on the machine cut? They do not pull any water off of me, they say they are cleaning my blood? They have cut the time before. I am on 3.5 hrs. I want to know if you think 30 min would hurt as it would make my sitting there holding my urine a little more tolerable. The doctors at that dialysis center will not listen.

The duration of your treatment is based on two things.  It is based on getting your blood clean with each treatment and also removing the fluid weight that you gain between dialysis treatments.  If your phosphorus is still high, and … Continue reading

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

Hi doctor My mother is 72 years old and highly diabetic. Now her creatinine is 3.Please advice for a better treatment.

Your mother should see a nephrologist and have testing of protein in the urine and testing for remaining kidney function.  The nephrologist can then recommend proper treatment for her chronic kidney disease (CKD). For more information on Diabetes click here:

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

I have donated a kidney and 7 years later I am developing hypertension which I have learnt affects many kidney donors. Why 7 years later and not when the kidney is donated? Exactly what happens to the remaining kidney that causes hypertension so much later and not immediately? I would expect that one larger kidney works better than one small kidney.

High blood pressure (hypertension) can be caused by many things and it is difficult to say that removing a kidney causes hypertension.  Long term follow up studies find an increased incidence of hypertension and small amounts of protein in the … Continue reading

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

Hi Doctor, My uncle (60) has been suffering from CKD recently and his creatinine levels are 8 currently. He is diabetic and his bp is fluctuating ( which we suspect is cause of CKD ). He has undergone two sittings of dialysis, one on Wednesday and another, the next day of this month. Doctor says there is no other option but to undergo dialysis for rest of his life. My first question is will these two dialysis sessions alone, bring the creatinine levels down?. And second Is, are there any alternative for this process (dialysis)? As we all know dialysis is a pretty frightening process for the patient and can be depressing at times.

Dialysis does decrease the blood creatinine concentration, but it will again increase between dialysis sessions.  The only options are dialysis and transplantation.  It is possible to refuse dialysis and continue to be ill from chronic kidney disease (CKD).  Your uncle … Continue reading

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