Category Archives: Ask the Doctor

Do you have any questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask away. Dr. Leslie Spry is happy to provide answers to all your kidney-related questions. Check back soon for answers!

I’m a male, 36 years old, 5’9″ and 165lbs. I do not have CKD, diabetes, or high blood pressure to my knowledge. I have tested negative for protein on multiple urine dipstick tests. My serum creatinine on my last blood test (done for a yearly physical) was 0.94mg/dl which I believe makes my eGFR 104. Roughly 18 months before that (the last time I had blood drawn) my serum creatinine was 0.84mg/dl. At that point in time (18 months ago) I was only about 145lbs after a pretty dramatic diet. The weight came off very quickly, too quickly probably, and I would consider 145lbs underweight for me. I’ve since returned to what I consider my normal weight and would consider myself in overall better physical condition. I have been a regular runner for the last year or so. My question is this: Is a fluctuation of serum creatinine from 0.84mg/dl to 0.94mg/dl over ~18 months within normal fluctuation range, and alright, all things considered? I know my eGFR comes out good on both of those tests, I just don’t know if slight fluctuations in serum creatinine level from year to year is normal. I assume so, since my doctor didn’t mention it, but I just wanted to confirm. This question may seem silly since everything is in normal range on both the tests, but I’m just curious about the change from 0.84 to 0.94 over ~18 months. Apologies if this is the wrong place for me to ask a question like this, I was googling (probably not a good idea) and this website seemed to answer many questions about this stuff, obviously. I really appreciate your time. Thank you very much.

The normal laboratory variation is plus or minus 0.10 milligrams per deciliter (mg/dl). This means that the serum creatinine can vary from one day to the next by 0.10 mg/dl. Hence, the variation of your results as given at 0.84 … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions, Serum Creatinine

I have been diagnosed with IgA Nephropathy and I have been on medication for the past 2 years and am doing pretty well. My Serum Creatitine- 0.99, Serum Albumin- 3.4, Hameoglobin- 10.2. No Sugar, No thyroid, no Cholestrol. My only symptom has been Foamy Urine. I am doing good as of now, but I am a little bit confused with my reports recently. My urine routine results have been showing as PROTEIN / ALBUMIN as NIL. But while doing the Random Urine Protein Creatitne ratio, my ratio comes as 1.3, 0.9, 0.8 etc. I am confused if the urinary protein is NIL, then how does UPCR show high values? For example, when my UPCR was 1.3, my protein total is: 24.20 and creatinine: 18.22. The ratio for this comes as 1.3. Can you help me understand my report? Which is more effective? Urine routine showing Protein NIL or UPCR showing 1.3? If protein is NIL, how does UPCR have high value?

The urine protein to creatinine ratio is a calculation that involves dividing the urine protein concentration (units should be milligrams per deciliter or mg/dl) by the urine creatinine concentration (units should be the same) and the result should be in … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions, Serum Creatinine

How can phosphorus be controlled when on dialysis and should one stop eating any food containing phosphorus?

This should be discussed with the dietitian assigned to you on dialysis. The dietitian is best able to review your current diet and suggest changes that will result in a more normal blood phosphate level in a dialysis patient. The … Continue reading

Posted in Ask the Doctor, Dialysis, Diet/Nutrition, Kidney-Related Health Questions

My urine creatinine is low, protein is normal, but my protein-creatinine level is very high. I have very little muscle mass due to myositis; I’m very underweight. My doctor said my kidney function is “fine” and “stable”. Doesn’t a high ratio indicate kidney disease? Could a high ratio indicate something else?

In many cases, this is a problem with units of measure for each of these components. The units for urine creatinine should be milligrams per deciliter (mg/dl) and the units for urine protein should also be mg/dl. This would yield … Continue reading

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

For membranous nephropathy, does rituxan or prednisolone/cytoxan have a better cure rate, less chance of reoccurance and side effects? Is there anything to consider when choosing treatment? Thanks.

There are no studies comparing Rituxan (Rituximab) with Cyclophosphamide (Cytoxan)/Prednisone combination. The recent discovery that Anti-Phospholipase A2 Receptor (Anti-PLA2R) antibody is often associated with primary membranous glomerulonephritis has allowed us to understand some of the potential causes for this kidney … Continue reading

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

I am a stage 4 knocking on the door of stage 5, I also had a transplant 29 years ago when I was 15. In the past when my feet swelled up I could take a Lasix and urinate off the water weight. Now when I take a Lasix, I still urinate a lot but my feet remain swollen – and hurt. It feels like they’re going to rip open. When that happens, I’m usually able to walk off the water weight but some days I can’t walk due to knee pain (I have bad knees). I want to know if there are any home remedies I can try besides putting my feet up. I work from home, so it’s easier for me to try things compared to when I was in an office. My next Dr appts are in 6 weeks (nephrologist and transplant center) so I will ask them then as well.

The most important thing to do to prevent swelling is to stay on a low sodium diet. I would recommend that you limit your sodium intake to less that 2300 milligrams of sodium per day. Elevation of your legs from … Continue reading

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

I’ve been undergoing testing to donate a kidney to a friend who has a very difficult match. I’ve lowered my BMI and my cholesterol and undergone much repeat testing. The (hopefully) last hurrah is to identify the cause of the chronic trace of blood in my urine. I’m having my bladder scoped in 2 wks. If that is negative for any cysts or polyps, the next step they want to do is a kidney biopsy. This has been an 18 month journey. My nephrologist says that I will be rejected if this reveals TBM. Everything I’ve read about TBM says it’s basically asymptomatic and doesn’t interfere with good kidney function. I’ve never had a UTI in my 66 years. To admit the frustration my recipient and I are experiencing, you’ve probably heard it all! Any insights or words of wisdom? 2nd opinion? Thank you.

Thin basement membrane (TBM) disease is an uncommon disease that causes blood in the urine and is commonly associated with normal kidney function. There are no nationwide guidelines that tell you what to do for TBM patients and allowing them … Continue reading

Posted in Ask the Doctor, Kidney Biopsy, Kidney-Related Health Questions, organ donation

Dear Respected Sir, My father age 67 years had hematuria last December twice. Ultrasonography, CT and other tests confirmed there is RCC (2x3mm mass) on RT kidney. A partial Nephrectomy was done by a leading urologist at New Delhi. As follow up CT-Scan was again repeated after three months which is clear as per report, no growth or mass seen. Kidneys are normal. Medicines prescribed: Silodol 8mg and Amelovas 2.5mg regularly to keep prostrate and blood pressure under control. Although no complaints of higher BP mostly. Recently a blood test was done which is showing higher levels of serum creatinine (1.8mg/dl). Kindly suggest main reason for higher levels of creatinine and remedial measures to control it. Regards.

I am unable to make any specific diagnosis based on the information that you present. It is most likely that the creatinine elevation is related to the recent kidney surgery but high blood pressure could also be contributing. I suggest … Continue reading

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

Hello. My father is 60 years old. We did a health check up and his serum creatinine levels are 2.29. Potassium is 5.52. Triglycerides – 299. HDL cholesterol – 26. Non HDL cholesterol – 133. Chol/HDL ratio:- 6.1 LDL HDL ratio: 3.2 Very low density lipoprotein: 59.8 Albumin: 3.4 Globulin: 3.3 AG ratio: 1.0 Chloride: 107 Calcium: 8.4. His haemoglobin is around 12 and his vitamin d3 is 14.4. We did a urine regular test and few bacteria were detected and protein was not detected. After two weeks, we did a 24 hour protein test in which the reports say the protein is 262. The tablets he has been taking since Friday are: Synprotik Septasteril Septa Q10 180 mg Sodanet ds Amlogard 2.5 mg Anxit D. 0.25 mg. Kindly advise on what foods to eat and avoid. We are pure vegetarian. Thanks.

I would suggest that you discuss this with a dietitian in your country. He will need to be on a low sodium and low potassium diet. It is best to have the dietitian review what your father is currently eating … Continue reading

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

Hi. In a recent ultrasound report, my right kidney size appears to be 13.6 cm and left kidney measures 12.2 cm. Right kidney appears to have hydronephrotic lower moiety with dilated renal pelvis measuring 5.9×8.6×9.0 cm ( AP×TR×CC). Should I be worried? Though I just have slight flank pain and no associated symptoms such as fever or chills. But is it an emergency?

The problem that you pose is a urological problem. I am an nephrologist and I have no surgical expertise. A urologist deals with blockage and growths in the kidney. Your situation should be reviewed with your primary care physician and … Continue reading

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