Category Archives: Diabetes

I am writing about my mom, 79 yrs young. She still hauled grain to the elevators this summer in the grain trucks. As of late, the GP has had some concern of anemia, and some leg swelling. A few months ago she had emergency gall bladder removal surgery, and several days later kidney function declined significantly, gfr was down to 15. After a few days and testing, the situation corrected itself to gfr of 51 The GP sent her to nephrologist. He did a battery of tests. CBC RBC 3.69, Hemoglobin 11.3, Hematocrit 34.5, ESR elevated to 55, Iron, IBC and Ferrtin, in normal ranges, IFE and PE are within normal vales, no M spike observed. LD normal range. Bun 29, creat 1.0, albumin 2.9, BUN/Cret 27.9, UA protein 71.1 mg/dl, UA creat 133.7 md/dl, UA protein/creat ration 0.532, Uric acid 8.2 mg/dl, Free Kappa Lt Chains 63.4 (H) mg/L (3.3-19.4), Free Lambda Lt chains 78.3 (H) MG/L (5.7- 26.3) But Kappa/Lambda radio is 0.81 (.26-1.65) which I was told was good. Blood smear was unremarkable, reds and whites of normal size and shape and appearance. Doctors unsure. Nephrologist was not concerned, and didn’t think kidney disease would progress (stated stage 3a ckd) so no special instruction or diet, other than avoid NSAID. GP thought Iron problem, but iron test show otherwise. Endocrinologist not sure, happy with A1C 7.0, using Lantus and R on sliding scale. Only other meds are Sotalol antiarrhythmic for a. fib, and a statin. The only thing that was not run was an EPO level, with the comment made that the kidney disease was not severe enough to cause a problem with EPO causing the anemia. Reading, many of the above could be explained by chronic kidney disease. Any ideas or impressions ? Thank you

I am not able to make a specific diagnosis based on the information that you present. Since she has diabetes, heart disease with atrial fibrillation, and a recent episode of acute kidney injury, she does have significant risk factors for … Continue reading

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

Hi Doctor. My mother suffered from kidney problems due to diabetes, but now controls blood sugar and blood pressure, and her vegetarian diet. My mom, age 57 and her weight 79. She A1c=5.6 creatinine=2.15, BUN=22. What is your solution to lowering creatinine and BUN and lowering protein excretion from urine? Do you consider a particular method or treatment? Or a special drug for use to help with this problem? Can Ketosteril and alpha lipoic acid be helpful to reduce Creatinine and BUN? And Is it useful for protein excretion? Thanks

Your mother likely has diabetic kidney disease. This is diabetes which has damaged the kidneys and will likely cause progressive disease. Once diabetes has caused damage, this damage is not reversible. Blood pressure should be controlled with blood pressure medications … Continue reading

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

Good day doctor, a diabetic patient for 17 yrs, hypertensive for 6 months, suffering diabetic nephropathy. The hypertension has refused to come down, saw a nephrologist but hasn’t been able to bring my htn down. Am suffering serious edema, back pain, leg pain and swollen legs because of fluid, was placed on diuretics (frusemide) but it is not bringing down the edema. I have creatinine of 1.20 and protein in urine of +. I did a test for microalbuminuria and it is 814mg/dl. My sugar level is normal. For sometime now I am suffering serious proteinuria, albuminuria, hypertension, edema on different part of my body, back pains and leg pains presently. Please kindly help me with drugs to reduce the protein in my body and a good diuretic i can use to reduce/stop the edema, also drugs to bring down the htn because it has been 165/107 and no drugs i have used seems to work. My nephrologist managing all this is not helping me because no improvement. I don’t want total failure of my kidney. Please give me other medical advice. Thank you.

Your description is of severe diabetic kidney disease coupled with severe hypertension (high blood pressure). I am unable to recommend treatment without performing a complete history and physical examination. It is important for you to follow a very low salt … Continue reading

Posted in Ask the Doctor, Diabetes, Hypertension/High Blood Pressure, Kidney Biopsy, Kidney-Related Health Questions, Nephrologist

We just found out today that my wife has stage 3 kidney disease. She has no s/s or history of diabetes or HTN but has had progressive symptoms of kidney disease for the past 2 years. How common is kidney disease in the absence of diabetes and/or HTN? Does that often mean better prognosis?

A majority of chronic kidney disease (CKD) in the United States today is related to high blood pressure and diabetes. There are numerous other causes of CKD. Some have a worse prognosis and others have a better prognosis. I am … Continue reading

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

I have Polycystic CKD with a GFR 42 – 46, BUN 27, Creatnine 1.7. I need to have a cardiac CTA with contrast in preparation for an A-Fib ablation. Could you help me understand the risks of CTA contrast? Thanks very much!

The use of iodinated contrast for computerized tomography (CT) scanning is a risk for patients with underlying chronic kidney disease (CKD). The risk is that patients will suffer acute kidney injury as a result of filtering the contrast through their … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Diet/Nutrition, Kidney-Related Health Questions, Polycystic Kidney Disease

I was considering using the Xyngular program to lose weight. I also wanted to make sure doing this plant and herbal based diet would not harm my kidneys. I have stage 3 kidney disease, diabetes(controlled), problems with recurring DVT(warfarin controlled), high blood pressure(controlled). The seller of this product says they have never heard of a problem like this with other customers. Could you please give me your opinion on this regime? Thanks in advance.

I read through the link that you provided and I am not aware of any studies that have been done with this product in patients with chronic kidney disease (CKD). You are also taking warfarin for a blood thinner and … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Diet/Nutrition, Kidney-Related Health Questions

My 37 yr old daughter has type I diabetes and has stage 5 kidney disease. She is on the transplant list and has been told to start peritoneal dialysis. She wants to delay the surgery process of inserting the tubes for two weeks which means her dialysis won’t start for 4 weeks. Is this a bad decision? Her only symptoms right now are edema. No problems with appetite or nausea.

I am unable to provide medical advice without performing a complete history and physical examination. The decision to start dialysis is generally one that involves both the patient and the nephrologist caring for the patient. The goal of dialysis is … Continue reading

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

Recently went to the ER and my blood glucose and blood pressure were high. On the blood test results it states, creatinine level 1.5, gfr level 48 and Bun level 17. I am scared that my levels will never return to normal however is it possible?

High blood pressure and diabetes both damage the kidney.  By correcting both, improvement might be possible, but some of this damage may be irreversible. By careful medical management, further damage to the kidney can be avoided.

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

I am a diabetic, since 2000, and I have problems sleeping at night. I also urinate 3-5 times at night. I take Metformin/Glibencamide 3x daily, as prescribed by my doctor. Grateful for your response at your convenience. Regards.

Passing urine during the night can be a sign of kidney disease or your diabetes not being well controlled. I suggest that you discuss your concerns with your primary care physician (PCP) and ask for further testing. This is a … Continue reading

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

Dr. Spry, My father suffered a kidney failure, apparently resulting from a UTI this past March. Though he is a long-term diabetic (over 27 years), his medical records state his condition as AKI rather than CKD. He is now dialysis-dependent, but his doctor seems to believe his kidneys could recover sufficient functionality for him to go off dialysis, though it’s been nearly 8 months since the diagnosis. What indicators would a doctor use to identify AKI vs CKD in a less obvious scenario where the UTI or the Diabetes could be the root cause, unlike an actual physical injury or nephropathy in the absence of a pathogen beyond diabetes, where I presume it would be easier to classify as AKI or CKD, respectively. How would the doctor determine if there is a possibility for some kidney function to return? From what I can tell of his creatinine, potassium, urea, albumin levels, there doesn’t appear to be a consistent improvement in any metric that would allow a quantitative assessment of kidney recovery. Is there a qualitative method to assess the viability of a kidney? Short of a biopsy is there another quantitative method outside the typical blood work to judge how much kidney function is just dormant vs. how much has been lost permanently? Apologies for the multiple questions! My father is being treated at the top hospital in his city, one well-known for international medical tourism (though he’s a local). His doctor appears to be a very competent and straightforward professional. Unfortunately, doctors in India are extremely reluctant to share technical patient information and I’m relegated to scouring the internet to help my dad navigate his condition. Thank you for any information you can share on the subject!

Acute kidney injury (AKI) means that the tubules of the kidney have been injured but the filters of the kidney (glomeruli) remain intact. If there is tubular injury, then the kidney is capable of repairing this injury and then the … Continue reading

Posted in Acute Kidney Injury, Ask the Doctor, Chronic Kidney Disease, Diabetes, Dialysis, Kidney Failure, Kidney-Related Health Questions, Urinary Tract Infection/Pyelonephritis