Daily Archives: July 15, 2021

Hello Dr. Spry, this patient is an 86 year old male, with hand grip 90 lbs, walking 2 miles daily, actively engaged in co-managing his CKD with his GP. His symptoms are pedal oedema and foot cramps in the morning as well as rare hand cramps, also metabolic acidosis buffered daily with 3X2 g of sodium bicarbonate. Diagnosis: Nephrosclerosis. G3b, A2 since 2014, at present eGFR 40 ml/min/1.73m2, ACR 4.5 mg/mmol. BW 72 kg, BMI 24.5 kg/m2. Comorbidities: T2DM, Essential Hypertension (both very long standing, under proper control for years), non-autoimmune Hypothyroidism. In his country the patient has no direct access to a kidney doctor as yet. Some relevant blood work results three weeks ago: PTH intact 11* (1,5–7,6) pmol/L;Total calcium 2,30 (2,15–2,50) mmol/L;free, ionized Ca  1,13* (1,15–1,35) mmol/L; free, ionized Ca [pH 7,4]  1,17 (1,15–1,35; Phosphate 1,1 (0,75–1,40) mmol/L; Albumin 38 (34–45) g/L; 25-OH-Vitamin D3 105 (50-178) nmol/L; 1,25-(OH)2-Vitamin D3 110 (60-210) nmol/L; Bicarbonate 24 mmol/L. Checking the history of PTH intact over the last 4 years it is found that PTH was always high except twice, when the 25-OH-Vitamin D3 level was at least 140 nmol/L. Questions: 1) Does the low ionized Ca level indicate that calcium is being lost from bone? 2) If so, in your opinion should this process be stopped? 3) If so, how? (Phosphate has been restricted to <1000 mg already for 5 years). 4) In your opinion, would it be desirable to increase the dosage of cholecalciferol taken until the level of 25-OH-vitamin D3 reaches 140 nmol/L? 5) Do you see any other problem and/or do you have any other suggestion(s)? Thank you, Dr Spry! Your much needed service is gratefully appreciated!

This 86 year old patient appears to be very well managed. The slightly low ionized calcium is related to his kidney disease, but for an 86 year old, this is better than I would normally expect. The mild elevation in … Continue reading

Posted in Anemia, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing | Comments Off on Hello Dr. Spry, this patient is an 86 year old male, with hand grip 90 lbs, walking 2 miles daily, actively engaged in co-managing his CKD with his GP. His symptoms are pedal oedema and foot cramps in the morning as well as rare hand cramps, also metabolic acidosis buffered daily with 3X2 g of sodium bicarbonate. Diagnosis: Nephrosclerosis. G3b, A2 since 2014, at present eGFR 40 ml/min/1.73m2, ACR 4.5 mg/mmol. BW 72 kg, BMI 24.5 kg/m2. Comorbidities: T2DM, Essential Hypertension (both very long standing, under proper control for years), non-autoimmune Hypothyroidism. In his country the patient has no direct access to a kidney doctor as yet. Some relevant blood work results three weeks ago: PTH intact 11* (1,5–7,6) pmol/L;Total calcium 2,30 (2,15–2,50) mmol/L;free, ionized Ca  1,13* (1,15–1,35) mmol/L; free, ionized Ca [pH 7,4]  1,17 (1,15–1,35; Phosphate 1,1 (0,75–1,40) mmol/L; Albumin 38 (34–45) g/L; 25-OH-Vitamin D3 105 (50-178) nmol/L; 1,25-(OH)2-Vitamin D3 110 (60-210) nmol/L; Bicarbonate 24 mmol/L. Checking the history of PTH intact over the last 4 years it is found that PTH was always high except twice, when the 25-OH-Vitamin D3 level was at least 140 nmol/L. Questions: 1) Does the low ionized Ca level indicate that calcium is being lost from bone? 2) If so, in your opinion should this process be stopped? 3) If so, how? (Phosphate has been restricted to <1000 mg already for 5 years). 4) In your opinion, would it be desirable to increase the dosage of cholecalciferol taken until the level of 25-OH-vitamin D3 reaches 140 nmol/L? 5) Do you see any other problem and/or do you have any other suggestion(s)? Thank you, Dr Spry! Your much needed service is gratefully appreciated!