Daily Archives: July 11, 2017

Hi doctor, I am 22 year old. I have an endstage renal disease secondary to vesicoureteric reflux disease with bilateral hydronephrosis with frequent urinary tract infection. I was on CIC and I was labeled as Hinman syndrome. I underwent bladder augmentation in June 2012 with ileocystoplasty and I was cleared for transplant by Urology. I started dialysis in December 2012, through the left AV fistula. I am having dialysis 3 times per week for 4 hours and I tolerate dialysis well. Currently, I am making minimal amount of urine only few drops on nondialysis and continues on bladder irrigation per urethra. No history of blood transfusion and no history of recent urinary tract infection. Regarding kidney transplantation, should the old kidney be removed first in a separate procedure? Or should it be removed and the new one be transplanted in the same procedure? and is it possible to stop doing CIC postoperatively? More details about the presenting complaint: I am a product of cesarean section as I was preterm with prolonged incubation for 2 weeks and neonatal ICU. At the age of 5 years, I was presented to Pediatric Urology Department with chronic urine retention and chronic constipation. Investigation at that time showed a creatinine of 60 and ultrasound showed severe bilateral hydronephrosis and VCUG showed vesicoureteric reflux. I was treated with a urethral catheter to evacuate the bladder, and I was labeled as Hinman syndrome Current medications: 1. Calcium carbonate 600 mg t.i.d. 2. Renagel 800 mg t.i.d. 3. Mapa (Acetaminophen) 325 g tablet Past medications of the same issue: SPS (Sodium Polystyrene Sulfonate) Suspension, Rocaltrol (Cacitirol), Nephro-vite (Multivitamine: Vit B Complex, Vit C and FA), Sodium CL, Zinnate (Cefuroxime), Aranse (Darbepoetin), FeroSul (Ferrous Sulfate) 65 mg elemental Iron, Amlor (Amlodipine). Klavox (Amoxicillin-Add to dictionary), Cipromax (Ciprofloxacin), Normoten (Atenolol), Add to dictionary (Calcitriol). Lab tests performed: 1. HLA Antibody identification: PRA I Screen – Luminex ID: Positive Class I PRA II Screen Luminex ID: Negative Class II Luminex Solid Phase Assay 2. CBC: Hematocrit: 0.356 L/L Hemoglobine: 116 g/L MCHC: 326 g/L MCV: 98.3 fL MPV: 10.4 fL Nucleated RBC Absolute Auto: 0.01 10`9/L Platelet: 220 10`9/L RBC: 3.62 10`12/L RDW: 14.3% WBC: 5.75 10`9/L 3. Chemistry: Urea: 12.0 mmol/L e-GFR: 6 mL/min/1.73`2 PO4: 2.30 mmol/L K: 5.4 mmol/L creatinine: 985 umol/L Cl: 94 mmol/L CO2: 33.0 mmol/L ALT: 7.4 U/L The

The decision to remove your old kidneys must be made by a urologist.  I am a nephrologist and do not perform surgery.  A urologist is a surgeon and has expertise in regards to urinary tract disease and bladder disease that … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Symptoms and Side Effects, Treatments, Urinary Tract Infection/Pyelonephritis, Urological Issues

Dear Doctor, Please see the below recent lab reports for your reference. (Done on 24/06/2017) Urine microalbumin: 983 mg/dl, urine microalbumin/creatine ratio: 1262 mg/dl, Albumin:4.62, creatinine: 1.44, BUN:15.6, Total cholesterol: 275, Uric acid: 8. I have been taking Olmesarten 20 mg for 2 yrs for blood pressure. Then the nephrologist changed this tablet to Lercadip 20 mg, but after taking lercadip, I feel palpitation so again changed to Tab Micardis 40 mg. I have started taking Tab Micardis from last week only. Now the doctor advised me to go for renal biopsy. I am working in Dubai.

I am unable to make a specific diagnosis based on the information that you present.  You have kidney disease based on the increase in urine protein (microalbumin) but I cannot make any other diagnosis.  A kidney biopsy would clearly show … Continue reading

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

My 13.5 year old son with single kidney status has serum creatinine of 1.0 mg/dl. All electrolytes, urea and uric acid values are within the normal range. There is no blood or protein in the urine. Can you give your opinion on this? PUV done on 3rd day of birth. Born with hydronephrosis.

The problem that you pose is a urological problem.  I am a nephrologist and do not see children.  I suggest that you consult with a urologist.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Hydronephrosis and Hydroureter, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Urological Issues

What insect repellents are safe to use with CKD? I found info stating that DEET can be absorbed and cause kidney failure but nothing on percaridin and the others.

I am not aware of any concerns for insect repellents in patients with chronic kidney disease (CKD).  I have not not come across any information that suggest a concern for DEET in patients with CKD.

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Symptoms and Side Effects

My father-in-law, white age 89, has a microalbumin/creatinine ratio of 720. He has recently been diagnosed with type 2 diabetes and it is controlled with Actose and Metformin. He also takes Amlodipine Besylate for high blood pressure. A1C is 5.7. He has been diagnosed with Chronic kidney disease, Stage 3 moderate and told to avoid Advil and Aleve. He is experiencing swelling in his ankles. He self caths and has had a severe uti. I am very concerned about his kidney function. His family doctor says there is no need for concern. Should my father-in-law see a Nephrologist for further treatment?

Most primary care physicians (PCP’s) are very well able to manage patients with Stage 3 chronic kidney disease (CKD).  I commonly recommend referral for to a nephrologist when the estimated glomerular filtration rate (eGFR) is less than 30 milliliters per … Continue reading

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

I would like to donate my kidney.

I suggest that you contact the transplant center in your area to learn if you are a candidate to be a kidney donor.  Each kidney transplant center determines who can and cannot be a kidney donor for their particular program. … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney-Related Health Questions, Living Donation

My BUN level in Dec 2016 was 23 (range is 8-27). In June of this year it was 30. My microalbumin/creatinine in Dec. 2016 was 74.7 (range is 0.0 – 30). Is there food, supplements or medications that will lower these two levels? I am Type II diabetic but I am not on insulin. I have Stage 3 CKD

In general, patients with elevated microalbumin in the urine should be treated with either an Angiotensin Converting Enzyme Inhibitor (ACE-I) or an Angiotensin Receptor Blocker (ARB) agent.  This would be the standard treatment for your diabetic kidney disease.  I suggest … Continue reading

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

I do not recognize any form of chronic kidney disease (CKD) based on the information that you present.  Many of your symptoms are not specific to the kidney.  Normal estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per … 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

Hello. I’m from New Zealand. I’d like to know is there a treatment plan for patients with primary hyperoxularia type 2 post transplant?

Yes.  There is standard treatment for patients with Primary Hyperoxaluria Type 2 prior to end stage kidney disease and for patients with kidney failure related to the hyperoxaluria.  You should be managed by someone who is familiar with the disease … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Kidney Failure, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Transplantation, Treatments

I am 70 and have mccRCC and only about 2/3 of a kidney remaining. My creatinine runs about 2.4 to 2.9 (gfr around 16-19). I also have severe spinal stenosis with leg muscle spasms, particularly at night, causing lack of sleep. I was prescribed tizanidine (2 mg before bed), but on checking online information find that it is cleared through the kidney. Recommended cautions in patients with Chronic Kidney Disease.

I suggest that you consult with your physician and ask if the dosing of the tizanidine is proper for your level of kidney function.  The tizanidine dose may have to be adjusted for you kidney disease.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function, Treatments