Category Archives: Anemia

My father is aged about 66 years; had been suffering from diabetes and hypertension for the last fifteen years. He has been diagnosed and suffering from Diabetic Nephropathy. The Biopsy Report says “Shows renal tissue with 14 glomeruli, 3 are globally sclerosed. Glomerular compartment: Diffuse intercapillary mesangial matrix expansion, mild mesangial hypercellularity, paramesangial capillary wall thickening and narrowing of lumina. One glomerulus show ischemic tuft atrophy with dilatation of the Bowman’s space and capsular fibrosis. Extra glomerular compartment: Interstitial expansion with mild infiltrates of mononuclear cells. Focal tubular atrophy. IFTA <5%. Vascular compartment: Arteriolosclerosis and arteriosclerosis" His latest reports are: Hemoglobin: 9.2g / dL HbA1c: 4.8% Serum Urea Nitrogen: 13.5 mg/ dL Serum Creatinine: 0.8 mg/ dL Serum Sodium: 135 mEq/ L Serum Potassium: 5 mEq/ L Serum Chloride: 105.5 mEq/ L Total Protein: 5 g/ dL Total Albumin: 2.6 g/ dL Serum Globulin: 2.4 g/dL A/G Ratio: 1.1 25-OH Vitamin D Total: 18.5 ng/mL eGFR: 93.1 ml/min/1.73 sq min He has primarily been advised the following medicines by the Nephrologist: 1. ACE Inhibitors (Enalapril) 2. Calcium Channel Blocker (Cilnidipine) 3. Torsemide, if required 4. Aspirin Tab 5. Tenepride M Tab 6. Rosuvastatin Tab 7. Nexiron LP Tab 8. Logical Tab 9. Ferronemia Tab 10. Remylin D Tab His Urine Albumin/ Creatinine Ratio is 3047 mg/g. I just wanted to know whether the prescribed medicines are the best which can be given to him? Are there any chances of controlling proteinuria with the combination of ACE Inhibitors and Calcium Channel Blockers or should we try ACE Inhibitors and ARBs? We just want to slow down his renal deterioration and your valuable guidance is deeply solicited in this regard. Looking forward with high hopes.

I do not recommend the combination of an ACE-inhibitor and an ARB agent. This is not a good combination. I will assume that the Remylin D contains vitamin D that he is taking for a vitamin supplement. His vitamin D … Continue reading

Posted in Anemia, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diet/Nutrition, Hypertension/High Blood Pressure, Kidney-Related Health Questions

Can anemia be treated with iron shots instead of EPO? I’m concerned about the side effects from the synthetic hormone. Are other treatments available?

Anemia in patients with chronic kidney disease (CKD) should be treated first with iron, if the patient is iron deficient. Once iron deficiency is treated, then drugs such as erythropoietin (EPO) can be used. There are some study drugs that … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Clinical Trials/Studies, Kidney-Related Health Questions

I have been on a trial for Roxadustat for 8 years. On March 3, 2019, I was taken off the study after my platelets dropped from 95 to 20. I asked to return to the study after my platelets returned to 89. I am currently in late stage 4 CKD bordering ESRD. GFR 22, HgB 8.5, Creatinine 2.7 I have been having CBC’s every month for the past 3 years. Until the platelets dropped for unknown reasons, Roxadustat maintained my HgB at between 11 and 12. My Nephrologist and Hematologist tried steroids (Prednisone) to try and increase my platelets, which was not effective. We tried a homeopathic remedy of Vitamin K and that brought the readings back up to where they had been before the drop. I am trying to get access to Roxadustat for compassionate use, as my Hgb is now declining more rapidly and my nephrologist agrees that it was effective, but the administrator of the drug trial lab has been reluctant to restart me and says the study will be ending in September anyway. I was diagnosed with stage 3 CKD in 2010 and was informed then that I would likely be on dialysis within 2 years at the rate my kidneys were declining. I got on the Roxadustat trial first for a 27 week study in 2010. That study ended in December 2010 and then I got on an extended study which lasted until March 2019. I have avoided dialysis and having seen the statistics etc. do not plan on either type. I have been told by several Doctors that I am not a good candidate for Procrit or Aranesp due to inflammation diseases I have. My Neprologist has told me that transfusion is an option. I have thought seriously about traveling to China where Roxadustat is approved by the China FDA for use with dialysis patients and is expecting to be approved for non-dialysis very soon. Any suggestions?

There are a number of other anemia drugs that have trials other than Roxadustat. I am familiar with Daprodustat and Vadadustat and there are others. You may be able to find other trails that are available for other drugs. You … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Clinical Trials/Studies, Kidney-Related Health Questions, Nephrologist, Transplantation

I recently asked about my blood work-up results affecting my surviving kidney. I apologize for all of the acronyms used in previous question and appreciate your answer. I will re-ask with no abbreviations, only to possibly help someone else with the answer you give. I had a radical nephrectomy (RN) last year, due to Upper Tract Urothelial Carcinoma (UTUC). That cancer seeded into bladder and ended up having 3 malignant tumors removed by transurethral resection of bladder tumor (TURBT). I had another resection done recently to biopsy the bladder again and hemorrhaged 16 days later. They had to surgically stop the blood loss and remove clots in the bladder. They also did a pyelogram on surviving kidney to make sure blood wasn’t coming from there. I had cbc done during hospital stay and a week later. All showed low red blood cell count (2.37), low hematocrit (24.7) and hemoglobin (7.8). My gfr is 58. I have no heart issues that I am aware of. My blood pressure has been sporadic. Of course after the trauma of hemorrhage it was 80/42 all night but it has been ranging 132/62 to 130/92. I don’t have a nephrologist as my urologist is doing periodic diagnostics to make sure the cancer hasn’t come back to the surviving kidney so I am curious if the trauma from this incident and low blood work would affect my one kidney and is a 58 eGFR something to be concerned about? Thank you SO much for taking the time you do to answer questions for people. We ALL appreciate the time you put in!

With a single kidney, your estimated glomerular filtration rate (eGFR) would be expected to be in the range of 50 to 70 milliliters per minute per 1.73 meters squared. This would be expected if your remaining kidney was normal. The … Continue reading

Posted in Anemia, Ask the Doctor, GFR, Kidney-Related Health Questions, Nephrectomy / One kidney

I am 49 F, have one kidney due to RN from HG,T1 UTUC. EGFR range from 53 (1/21/19) to 58 (6/27/19). Dealing with after effects of NMIBC with ER bladder cauterize to stop severe clots/hemorrhage 16 days after 3rd TURBT. On 6/27/19 my RBC (2.37), Hgb (7.8) and HCT (24.7) are very low, creatinine 1.11 but MCV (104.2). These numbers still haven’t changed a week out from blood clot episode. Scheduled to see hematologist in a couple of days for blood transfusion, for we know this is bad anemia. My question is, will these low blood counts cause my one kidney to damage and should I try to get transfusion sooner?

I am not familiar with most of the acronyms that you use. I am not familiar with “RN” or “HG,T1 UTUC”. I am also not familiar with “NMIBC”. I presume that “ER” is emergency room and “TURBT” is commonly used … Continue reading

Posted in Anemia, Ask the Doctor, Kidney-Related Health Questions, Nephrectomy / One kidney, Nephrologist

What are the effects of Stage 3a Kidney Disease? Can high doses of Calcium increase your Potassium level?

Chronic kidney disease (CKD) is generally without symptoms. This is why it is difficult to know whether you have kidney disease unless you get blood and urine testing for CKD. Early stage CKD may result in mild anemia and some … Continue reading

Posted in Anemia, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney Stones, Kidney-Related Health Questions

My father has been suffering with CKD problems the last 1 year. Creatinine: 3.3, urea: 97, hb: 6.9, sugar (f): 147, sugar (pp): 207, bp: 179/85. He takes Zyroop 4000 ui twice a week the last four months. Eglucent mix 50 & Trajenta 2.5 for diabetes; Phostat 667 mg; Rocaltrol .25mg; Cilacar m 10/50; Prazopress xl 5mg; Rozustat asp 10/75.

I am unable to provide a diagnosis based on the information that you present. Your father appears to be suffering from kidney disease and possibly related to diabetes. He is also anemic. His blood pressure is too high. I am … Continue reading

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

My husband has been diagnosed with stage 3 kidney disease. He has multiple cycts on each kidney, but he has not been referred to a nephrologist or a dietician. His creatinine is now 142 and eGFR is 43. Also in his blood work his RBC keeps getting lower and myelo and pros show up as 1 in blood work occasionally. Is this concerning? Also anemic and was told to take OTC iron.

I am not able to make a specific diagnosis based on the information that you present. Anemia is very common in patients with chronic kidney disease (CKD). Once the estimated glomerular filtration rate (eGFR) falls below 50 milliliters per minute … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Nephrologist

I suffer from kidney disease. In July I had my right kidney removed. I now suffer from anemia and my iron level is 3%. They want to do an iron infusion and I am not sure I want to do this. Your assistance is appreciated. Thank you.

I commonly recommend iron infusions for patients with iron deficiency and anemia with kidney disease. Patients with chronic kidney disease (CKD) often cannot absorb iron very well and infusion of iron is the most appropriate treatment in this situation.

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

I have felt miserable with my dx of CKD Stage 4. I have had every test under the sun. I even see a therapist. My labs are stable considering having had this dx since Oct 2017. It came out of no where. Is there any kind of treatment to help. My biopsies stated that CKD came from Chronic Interstitial Nephritis. Biopsies done one year ago Jan 2018. I have become anemic, high blood pressure and high cholesterol since my dx. Does this chronic illness/disease continue to get worse? I have not seen or heard of any treatments unless my GFR is at 15. Mine is 20 now. I just feel as though I have searching for over a year for something. I cannot take this fatigue, lower back pain, dizziness, feeling faint, nauseau, unable to concentrate and mild confusion to go away. I get there is no cure but there must be something.

At some point, your nephrologist must determine that the symptoms you are relating are potentially treated by dialysis and transplant. You should be eligible to be evaluated for listing on the transplant list once your estimated glomerular filtration rate (eGFR) … Continue reading

Posted in Anemia, Ask the Doctor, Dialysis, GFR, Kidney-Related Health Questions, Nephrologist, Transplantation, Treatments