Daily Archives: June 14, 2017

Hi. I am female, 45 old from India. I have done RIRS in my left for 1cm and 5mm kidney stones on 9 may 2017. After they put stent on my left side. I have taken CT scan before stent removal. The CT scan report shows 4.2mm, 2mm, and 3mm stones on my left kidney. The stent removes on 5/6/2017. Now my question is my kidney function is normal? But now no blood in my urine. and urine color is normal. and amount also. Another question is Why is it painful?

I am unable to make a specific diagnosis based on the information that you provide.  The question that you ask is a urological question.  I am a nephrologist and I do not perform surgery.  I suggest that you discuss your … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments, Urological Issues

My husband gets blood work done every 6 months for the last 20 years due to a pituitary adenoma. His Comprehensive Metabolic Panel has always been normal until 2 years ago. His creatinine went from a 1.21 in January 2015 to a 1.46 in August 2015. He had a 24 urine test done in November 2015 and it showed normal kidney function. The doctor said kidney function was 110%. Since then these have been his creatinine results – (range 0.60 – 1.35mg-dl) 11/2015 – 1.33 1/2016 – 1.22 10/2016 – 1.39 12/2016 – 1.29 5/2017 – 1.37 All other results with the panel are normal. My question is – are these fluctuations anything to be concerned about? His diet hasn’t changed, all he drinks is water so he can’t be dehydrated (same amount all the time), exercise hasn’t changed either.

The laboratory values that you report for the serum creatinine on your husband are not different from each other.  These values are within normal laboratory variation for the serum creatinine test.  There is a natural loss of kidney function with … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diet/Nutrition, GFR, Kidney-Related Health Questions, Laboratory Testing, Serum Creatinine, Treatments

Hi, My husband is a sporadic diabetic. He had bypass surgery in 2005. Over the course of this past year, he started seeing a nephrologist for his kidneys. The doctor put him on sodium bicarbonate and at first numbers improved. We transitioned from the sodium bicarbonate tablets to baking soda 1/4 tsp per gallon of water on two weeks off two weeks. His numbers improved upon the first test after adjustments according to his doctor then the next test he showed too much sodium and we were told to cut back on his salt. We immediately cut down on adding the baking soda because we are already on a strict salt diet and this week were told he needed the sodium bicarbonate added back into his diet “he wasn’t getting enough”. His doctor is adding three tablets to his daily medications and when I asked about getting too much sodium and his heart health her response was that most kidney patients die from heart attacks. She is also suggesting he begin initiating the process to prepare for dialysis by taking a training course and getting vein mapping so they can schedule an appointment for surgery. I am going to request copies of all his blood work results Monday. She indicated his latest test was at 22 points gfr and that it had decreased 7 points from the prior test. before that it had increased and looked good but the only concern she had during the last appointment was his sodium levels. I have four questions. * It seems everyone is affiliated for several cities away and we would like a second opinion about getting dialysis. How do we go about getting this completed and can you help us after we get a hard copy of the test results? * What is your take on sodium bicarbonate? Is this the only thing that can help the kidney numbers improved outside of diets and dialysis (low potassium diet, low carb diet, etc.) His potassium levels are within normal range and his carbs are doing better than they ever running around 120 to 150. He used to have numbers into high 300 and low 400 for carbs.) Kidney disease is chronic and a direct result of his diabetes according to a number of medical health professionals. * Are there other options for stages three and four kidney disease? The only difference in medications lie in his vitamin D, calcitriol, and sodium bicarbonate. Yes he has low vitamin D levels too. He has moved between the two stages over the past year. When he was first diagnosed he was in stage 4 and we were told the numbers would not improve but after removing a large amount of protein he dropped to stage three but is now back to stage 4 since we reduced sodium levels via baking soda. * Is there a medication for the kidneys rather than going directly to dialysis that would work to slow the decline and possibly improve filtration? Example he had been put on a high protein diet when he had to have an amputation due to diabetes. We were never told to reduce the protein levels down until we moved and he ended up in the hospital here. As I mentioned earlier his numbers improved greatly after cutting out the high level of proteins that were meant to help him heal. I simply would like to know if there are other options, if so how well do they work? My husband has no swelling in the legs either. * Are there any contraindications for dialysis? I see on the web that primary concerns revolve around mental health issues and cancer issues which we are not affected with at this time.

You ask a number of questions that I am unable to answer without performing a complete history and physical examination.  Your husband has chronic kidney disease (CKD) and his diabetes, heart disease, high blood pressure and peripheral vascular disease make … Continue reading

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

My GFR keeps changing from GFR 27 to 32 then from GFR 29 to 34. I was getting ready to gain access point but now my GFR puts me back in stage 3. Please tell me why my GFR keeps changing and wilL I stay in Stage 3?

The estimated glomerular filtration rate (eGFR) is just an estimate and is not an exact number.  The laboratory testing does have some variability and will tend to vary from day to day.  The numbers that you quote are very similar … 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

I had a kidney transplant 16 1/2 years ago. And I went to see the nephrologist today and my blood work shows gfr at 27. He says chronic kidney disease stage 4, but doesn’t seem to concerned. My deal is I’m tired all the time. Have no energy. When I sit down I fall asleep. My wife says I am sleeping about 16 hours out of 24. I have high blood pressure and the dr has added another medicine for that as well. Swelling of the ankles and legs. Bad diabetic. I am 62 yrs old. Do you have any suggestions?

Your diabetes is likely contributing to your symptoms.  Poorly controlled diabetes leads to nerve disease, muscle disease, heart disease and loss of vision.  The diabetes can also be damaging your transplanted kidney.  Having a transplanted kidney for 16 1/2 years … Continue reading

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

My mother is a renal transplanted patient since 9 years. Her creatinine level is very good, 1.2 to max 1.9. She has controlled hypertension and diabetes. Everything was perfect. Since almost 2 months she developed a fever with vomiting and severe nausea ending in creatinine 5. She was hospitalized and given antibiotics and saline … then the case returned to normal and was stable… she was dismissed… after 2 days , she suffered from recurrence of previous symptoms in a more severe form and she was hospitalized one more time. She was treated with saline, antibiotics ( IV ) and after 10 days the case was stable again .. She was dismissed to continue her IV and oral antibiotics at home. She finished her antibiotics courses after a week at home and everything was great. Now after 2 weeks from her recovery, she developed a high fever again. The doctors said it is a urinary tract infection. Please advise us what to do. Whether there are some special investigations to be done? and how can it be treated in a way that prevents recurrence? and is that a sign of chronic organ rejection?

I am unable to make a specific diagnosis based on the information that you present.  I cannot recommend medical treatment without performing a complete history and physical examination.  Your mother has a kidney transplant and takes medication to suppress her … Continue reading

Posted in Ask the Doctor, Transplantation

My son in law is 30 yrs old. He has no kidneys due to Wegener’s Granulomatosis. He has had 3 failed transplants due to Humeral Rejection. Can you tell me if there has been any study’s on this or any progression on this disease? Do you know anyone I can contact? I’m willing to do what ever I need to to research and try to help him.

There are two forms of rejection that can occur with kidney transplantation.  The most common is cellular rejection, whereby the immune system attacks the kidney with T-cells and macrophages that can destroy the kidney.  This form of rejection is relatively … Continue reading

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

I am being evaluated at Mayo Clinic Florida for living kidney donation. My question is about how my kidney function will be when I go from two kidneys to one. My first creatinine clearance number was only 77, which the transplant doctor said was lower than she expected but still above the 73 needed for my age (56 years old). With one kidney I am concerned this number could be cut in half, and wouldn’t that put me in the CKD range? The second test result was 90. I am interested in getting an opinion from a non-transplant nephrologist about what might be the effects on my down the road. Thanks in advance.

Your thinking is correct.  By donating a kidney, you will expect to have a reduction in total kidney function as expressed as an estimated glomerular filtration rate (eGFR).  While the eGFR does not commonly decrease by half, after donation of … Continue reading

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

Can the high blood pressure medication Ramipril cause damage to GFR Kidney function? And if it can, what does one take as a replacement to control high blood pressure that doesn’t damage GFR Kidney function?

Ramipril is an angiotensin converting enzyme inhibitor (ACE-inhibitor) used to control blood pressure.  It also has a beneficial long term effect on kidney function. When the drug is first started, the estimated glomerular filtration rate (eGFR) may decline slightly but … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Medication and Kidney Function

My father is 75 with CKD and diabetes. Recently he has been treated with corticosteroid and antiviral for Bell’s palsy. Now his creatinine level has raised up from 3.13 to 3.35. Now doctor prescribed acetylcysteine 600 twice a day for 7 days. Is that gonna work anyway to lower/stable the creatinine level?

I am not sure why there has been a slight elevation in the serum creatinine.  This is a very slight increase and my not be significant.  The use of corticosteroids in this situation will cause the diabetes to be much … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Kidney-Related Health Questions, Medication and Kidney Function, Serum Creatinine