Daily Archives: May 11, 2018

I am one of the caregivers for my 79 year old father. He is Type 2 diabetic and started dialysis in Dec 2016 via AV fistula graft in upper right arm. In February, my father fell, broke his clavicle. He was in a rehab facility during his recovery. He started struggling with confusion, nausea (during and after dialysis), extreme cramping even hours to next day after dialysis and overall weakness. We discovered at that time that the dialysis center was continuously decreasing his dry weight to remove edema in his feet. They were trying to get him to 98 kilos (which is where he was in the fall) and after a Z-scan they discovered he was actually at 100k. They decided he was actually dehydrated and the problems got better and pretty much went away after they adjusted for the higher dry weight. My dad is generally what you would call the ideal dialysis patient. His facility sends home monthly reports of protein and calcium levels and such. Other than being low in protein, his numbers that are monitored are right in the middle the target zone. He says the nurses set him up and leave him alone because he doesn’t present any problems during treatment. We don’t know if this is normal or bad nursing. In the last 5-6 weeks the edema in his legs/feet has increased and the nausea has returned. The nausea is in the form of dry heaves, generally no stomach fluid and happen within 8 hours of dialysis. He has told me that he’s felt nauseated during dialysis and told the nurses he was cramping so they would adjust the machine. He said telling them about cramping got more attention than feeling sick. My family spoke to this doctor yesterday. His dialysis doctor keeps trying to decrease his dry weight to get the fluid out of his feet but it brings on the nausea. Her only response was we have to get the water out of his feet and that being on dialysis only offers poor quality of life and this was as good as he was going to get. We tried talking to his general doctor, she refers us back to the dialysis doctor. We tried talking to the nephrologist he used to see prior to dialysis and they refer us back to the dialysis doctor. We are considering taking him to a different facility, but are we just jumping from one hot pan to another? We have no idea who else to speak to or who to ask for help. No one will talk to us and the current dialysis doctor is not helping at all. Thus this email. Today he had an EKG, chest x-ray and carotid artery ultrasound done so see if there are other problems. My dad really struggled with dialysis in the beginning as it was an emergency start. But he finally settled into a routine and generally did well. He would be tired and sleep for about 1 hour afterwards and then perk up and be fine in between treatments. Since this trouble with dehydration, edema and nausea started since February, he can’t even walk out of treatment (needs a wheelchair) and can barely function between treatments. We know dialysis is an extremely hard way of living. We know that our dad is 79 years old and that adds its own set of complications. But is it really a disease that you just barely exist until your next treatment? Are we in a bad facility and need to move or is this just the way it is? Or is dialysis really just a disease that is like putting a band-aide on a severed leg? I know you can’t really answer some of these questions but how can we get help?

In some cases, it is necessary to be persistent. You and your family have the right to attend a multidisciplinary conference that is held about your father once per month at the dialysis facility. I suggest that you contact the … Continue reading

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

Good Afternoon Doctor: Apparently I have a small kidney stone(s) hanging out in my right side ureter tube (between my kidney and bladder) The last ultrasound also showed a small stone in my right kidney. I am in NO pain and I am not bleeding. In fact, I never felt the stone pass from my kidney to the tube. I also have hydronephrosis (sp) in the right kidney (no pain), Urinalysis shows no cancer cells. The doctor I am seeing is recommending surgery to insert a camera through my bladder to the tube to remove the stone and place a stynt there. Since I am in no pain this option does not appeal to me. I have been drinking lots of water and cranberry juice. I urinate often but not at night (presumably because I am laying down) Do you have any advice or recommendations other than surgery?

The question that you ask is a urological question. I am a nephrologist and have no surgical expertise. A urologist is a surgeon and has expertise in kidney stone disease and blockage of the kidney.  I suggest that you seek … Continue reading

Posted in Ask the Doctor, Kidney Stones, Kidney-Related Health Questions, Nephrologist, Urological Issues

I am currently receiving dialysis treatment at a clinic but want to begin home peritoneal dialysis for all the obvious reasons. Five years ago, I had a kidney removed with laparoscopic surgery and I have no scar tissue complications. Could I pursue peritoneal dialysis?

Peritoneal dialysis is always a good option if your abdomen contains no scar tissue. In most cases, the only way to know if you are a candidate is to agree to have a peritoneal dialysis catheter placed for dialysis and … Continue reading

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

What medicine should I take if I have high levels in albumin?

I am not able to make a specific diagnosis based on the information that you present.  I am not sure if your blood or urine levels of albumin are high. I suggest that you consult with your physician and have … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions

Hello I am a kidney transplant recipient getting ready to hit my 28th year with my transplant. I’ve always wondered with someone as far out as I am and even someone not so far along what is the normal times for urination. What I mean is how many times would someone who just received their transplant go to the bathroom, compared to someone who is further out from when they received a donor? Is there really an average or does it vary from person to person?

Each person is very different and the frequency of urination depends on many factors including how much fluid you take, your bladder and prostate status, and your age. If your chemistries remain in a good range and your blood levels … Continue reading

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

I am 47. My GFR rate is 70 with 83 being the African male number. What number do I go by? I am white but muscular and my blood creatinine level is at the top end of 1.13. No protein showed in my urine but my doctor found blood. I am scheduled for another test in 2 weeks. My question is about the GFR. Can it be 70 at my age and be healthy? According to charts/formula I have seen my GFR should be around 93. I am a nervous wreck. Thank you.

You should use the chart created for non-African American males. A normal estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per minute per 1.73 meters squared. Your eGFR is within the normal range. Unfortunately, our estimating equations for … Continue reading

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

Does drinking energy drinks put you at risk for kidney failure?

Energy drinks generally have large amounts of sugar and caffeine and may lead to weight gain and an elevated blood pressure. I suggest that you review your intake with your primary care physician (PCP) and see whether this is a … Continue reading

Posted in Ask the Doctor, Hypertension/High Blood Pressure

I have secondary FSGS stage 3. Is the ketogenic diet safe for me? I’ve been eating keto for months and feel amazing. I have lost 30lbs and have been able to drop one of my BP meds and my cholesterol meds. Some say keto is bad for the kidneys, are you familiar with this way of eating? I have little to no carbs each day.

The Ketogenic diet has been shown to promote weight loss and may be helpful in lowering your blood pressure. In some cases the Ketogenic diet may lead to malnutrition and this may have to be monitored. If you are eating … Continue reading

Posted in Ask the Doctor, Diet/Nutrition, Hypertension/High Blood Pressure, Kidney-Related Health Questions

Over the last three months I have seen my creatinine levels increase and Gfr decrease. I raised my concern to my urologist. He said I should not be concerned but ordered a renal ultrasound. He added that if something was found he would refer me to a kidney expert. The ultrasound results indicated normal, no abnormalities. I discussed results with my urologist and he said there was no need for concern and he would see me in six months. I have no symptoms (ankle swelling etc.) However, I have read that in most cases of kidney problems there are no symptoms. One symptom is bubbly urine. I do not want to wait until it’s too late. Current creatinine level is 1.44 and Gfr is 52. I am 83 years old.

I recommend that you have urine testing for blood, protein and infection. If these results are abnormal, then consulting with your primary care physician (PCP) or a nephrologist may be indicated. The estimated glomerular filtration rate (eGFR) that you quote … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diabetes, GFR, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Nephrologist

During a routine colonoscopy, I was told to take a daily dose of Benefiber. I have a history of kidney stones having had 5 ureteroscopy and presently have a 3 mm kidney stone. Doing research online I get conflicting results regarding benefiber and kidney stones. Does the fiber in benefiber pass thru the GI tract instead of the urinary tract? Can I safely take a daily dose of Benefiber? Thanks.

Benefiber is a non-absorbable source of fiber and should not effect any urinary elimination of minerals involved in kidney stones. The fiber is eliminated by the bowel (GI tract).

Posted in Ask the Doctor, Kidney-Related Health Questions