Category Archives: Diabetes

What are your thoughts on using canagliflozin for those with increased albuminuria?

Canagliflozin (Invokana) and Empagliflozin (Jardiance) are Sodium/Glucose cotransporter 2 inhibitors (SGLT2 inhibitors).  They are used to treat Type 2 diabetes and they cause the kidney to eliminate glucose in the urine.  This can lead to weight loss and also can … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, GFR, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Microalbuminuria

My boyfriend is 44 yrs old has gout,type 2 diabetes, reduced kidney function, hx of kidney stones and hypertension.They have referred him to a nephrologist and rheumatologist and podiatrist.Which specialist would be the best to be able to get the optimal treatment? I read an article on this site referring to that suboptimal care given to patient with gout and ckd.

I believe that a nephrologist should be able to address most of the issues that you mention.  A rheumatologist could address the issue of gout and I’m not sure what a podiatrist might be able to offer.  All of the … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Gout, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Nephrologist, Treatments

I am kidney transplant recipient for last 6 months. Creatinine is now 1.2. I am also diabetic patient. My height 5 feet 7 inches and weight 70 kgs. Age 63 years. I received organ from living donor. How much water and protein I should take daily? Presently on insulin and immunosuppressant medicine.

You should follow a DASH diet and drink water to your thirst.  It is not necessary to drink a specified amount of water.  You should also follow a low salt diet.  You can review the DASH diet at:  https://www.nhlbi.nih.gov/health-topics/dash-eating-plan

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Diet/Nutrition, Kidney-Related Health Questions, Living Donation, Serum Creatinine, Transplantation

Recently I went into Stage 4 of kidney disease.  My GFR is 17 and creatinine was 3.66.   I do have high blood pressure but is pretty good with meds (140/80)…also diabetic with an avg reading of 139.  I really am watching my sodium intake and potassium (levels were good with last blood tests).  Old remedy I am told is vinegar with the mother (1 tsp per day with glass of water).  What are you thoughts or experience with this old remedy?   I do drink a lot of water to keep hydrated and flush the kidneys.

I have had many patients mention this to me.  I have never seen any study that suggest that vinegar is of benefit in patients with chronic kidney disease (CKD).  I have not observed any ill effects and I have not … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, GFR, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Treatments

Doctor glad to greet you, My question is that I have creatinine at 2.70 and glomerular filtration at 20%. Are these values of chronic kidney disease very alarming? To start with the transplant? I don’t have diabetes or high blood pressure, my sodium tests partial urine glucose are fine. Under the creatinine 2 points and glomerular filtration rose 1 point I do not know how I can know what happened to my kidneys I can not biopsy because my kidneys are small, Doctor you can say about it? Thank you

Your estimated glomerular filtration rate (eGFR) is 20 and this would be consistent with Stage 4 chronic kidney disease (CKD).  When your eGFR is less than 20 milliliters per minute per 1.73 meters squared, you could be eligible to apply … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, GFR, Hypertension/High Blood Pressure, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Transplantation

I am a male of 55 yr. I am a diabetic and high BP patient too. Diabetes was seen 12 yr earlier and high BP was seen from last year. Currently hydronephrosis was detected in ultrasound with 10mm loss of parenchyma with left kidney swollen. X ray also shows the swollen kidney. So what do you suggest? Should I remove the left kidney or leave it as it is? Note* no kidney stone was detected in my whole life and my RFT test is normal.

I am a nephrologist and I have no surgical expertise.  A urologist is a surgeon and deals with surgical treatment of the kidney and lower urinary tract.  I suggest that you consult with a urologist about your situation.  

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Hydronephrosis and Hydroureter, Hypertension/High Blood Pressure, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing

Hello Dr. Spry I’m 36 years old , I underwent pre-emptive kidney transplant on 17/4/2019. I was diagnosed with medullary sponge kidney since 2005 ( as congenital case ) My GFR was 55 ml/Min at Cr 2.0 mg/DL The progression of my case took almost 14 years until Feb, 2019 where my GFR dropped to 15ml/Min at Cr 6.6 mg/DL My brother donated his kidney and the transplant was successful. I was discharged to ICU then to my room after 24 hours at Cr of 1.1 I started with immunosuppressive agents immediately Prograf ( Tacrolimus) 7 mg daily Cellcept ( mycophenolate mofetil) 500mg *4 Prednisolone 15 mg daily By August ,2019 creatinine jumped to 1.5 My nephrologist asked for U/S and it was normal Then he asked for biopsy that showed BK virus infection. In parallel , I was suffering from severe diraheaa caused by Mycophenolate ( cellcept) And I was admitted to hospital for 48 hrs where I underwent biopsy and colonoscopy since my weight decreased significantly. During my stay in the hospital,, I was connected to normal saline IV Creatinine dropped to 1.3 Accordingly , nephrology team suggested that I suffered from dehydration due to diraheaa . So they lowered the mycophenolate dose and raised the steroid and Tacrolimus. My weight started to increase . Diraheaa immediately stopped and creatinine remained 1.3 and my overall health improved. Last week Creatinine jumped to 1.6 Prograf level 8.6 ng/dl Hb 13 My nephrologist informed me that he had no significant illustration to this case. He asked me to repeat the Cr and prograf level next week , if it remained 1.6 or more He will ask for U/S and if it was normal he will go to second biopsy. By next week I will finish 6 months ( post transplant). On the other hand,, my brother ( Donor) was discharged at Creatinine 1.3 One month later it was 1.5 , and since that date it remained 1.5 He is not suffering from any illness and his overall health is perfect He is 50 years old ( non diabetic , non HTN) His medications are : Aspirin every other day Crestor 10 mg daily My questions are : 1. are these complications post transplant normal ? Especially I never undergo dialysis? HLA 70% , lymphocytotoxicity ( negative) 2. is it normal or accepted to go for second biopsy? 3. What is your assessment to my case , and your recommendations? 4. What is your assessment to my brother case , and your recommendations? Thanks a lot for your efforts , waiting for your kind reply. Regards.

I am unable to give medical advice without performing a complete history and physical examination.  The course that you describe for you post transplant events are not uncommon.  The first six months after a transplant are generally the most unpredictable … Continue reading

Posted in Ask the Doctor, Diabetes, Kidney Biopsy, Kidney-Related Health Questions, Symptoms and Side Effects

In 1996 I had total organ failure from alcoholism that caused acute ascites. I went from 215lbs to 305 Lbs in 2 weeks and turned yellow. A tap was placed in the abdominal space and 65lbs of fluid was drained in 5 days. That resulted in metabolic shock and total system failure. Heart, kidneys, liver all shut down. Initial blood readings were Creatine 11.5, Bun 145, and SGOT/SGPT/GGtall well over 150. I had terrific docs and the benefit of being 29 years old. My Nephrologist did not start dialysis as most may have, instead as long as the readings improved daily no dialysis. I spent 6 months in the ICU. Recovered after 1 year and have had no issues since. My blood Creatine reading ranges between 1.9-2.9. Has been consistent for the last 23 years. 8-10 years ago in my early 40, I struggled with gout and spent 6/8 years on allopurinol once daily. Also, blood pressure was high with systemic changes to the cardiac muscle. However, as I aged, I better disciplined myself and I am now 168lbs at 70.5” and I usually eat only one meal a day with some sort of high protein snack to tied me over. Now I have been off the allopurinol for 2 years and off my blood pressure meds for two years. I feel good and at 52 my blood glucose was 80 last labs. I know if I do anything to further damage my weakened kidneys such as drink again or take NSAIDS I could cause premature kidney failure. However, if I do not damage them by bad habits or too many OTC pain killers what is the potential for my kidneys to never be an issue until I live a normal 70-80 year lifespan? If they have not worsened in the last 23 years, baring me doing damage or developing type II diabetes, can they not last another 23 years and not fail prematurely? Several doctors have limited my life to 60-65 years due to the alcoholism and the resulting multi-organ failure. Most don’t expect me to live a normal life span. I understand that if I still drank or if I was 275 lbs again with gout every 2 weeks. Yet I haven’t had those issues for several years. I know the diabetes could change everything. Yet, my blood glucose has always been 75-85. BP is now consistently 118/76 or better with pulse at 80 or below. I am a male and 52 years old. I am 5’10.5” weight consistently between 165-175. I take a baby aspirin now and that is all. The system failure occurred in 1996 at the age of 29. After a year I had all normal organ blood level readings except for the Creatine of 1.9. At 170 LBS it stays 2.0or below. When I would gain up to 275 lbs the Creatine would increase to 2.9-3.0. I have been sub 180 since I turned 50, and Creatine has been 1.75-1.9. I have had no treatment of any kind since I left the hospital in 1996. What does the future hold for my kidneys if I don’t ruin them by drink or drug? How devastating would diabetes be to someone like me? I have no pre diabetes now and since age 46 I have had blood glucose tested every 6 months with my Creatine. It has been 80 average for 6 years. Can I expect my kidneys to continue to work without a hiccup or are those many doctors correct who pegged my life span at 65 not that of an average man? Thanks doctor!

Your story is certainly an extraordinary account of severe illness that seems to have stabilized and you have adopted a remarkable change to your lifestyle. I don’t know that anyone can forecast the future with that degree of precision.  In … Continue reading

Posted in Acute Kidney Injury, Ask the Doctor, Chronic Kidney Disease, Diabetes, Kidney-Related Health Questions

I’m a 43 years old male with chronic kidney disease, high blood pressure and I am pre-diabetic. I’m very preoccupied because I don’t know what kind of diet should I follow. Would you please help me? Also, medicines are super expensive and would like to check with the foundation if they can help me with the medicines. I will appreciate your help. Thank you.

I am a strong proponent of the DASH diet.  I suggest you limit your salt intake and follow a DASH diet.  You can review a DASH diet at:  https://www.nhlbi.nih.gov/health-topics/dash-eating-plan You should also exercise and try to lose some weight as … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Diet/Nutrition, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Symptoms and Side Effects, Treatments

I have had kidney failure/insufficiency 3 times this year. I always have hyperkalemia when this happens. I am restricted to 32 ounces of liquid; however, they always say I am dehydrated. What am I doing wrong? Will this keep happening or is there something I can do? I am a diabetic.

I am unable to make a specific diagnosis based on the information that you present.  I can only suggest that you visit with your nephrologist and ask for a specific diagnosis at to your kidney disease.  A specific diagnosis is … Continue reading

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