Category Archives: Nephrologist

Canadian health care guidelines allows a CKD patient not to have dialysis even if the eGFR is 6. They say CKD patients can live a normal life even at that low number without dialysis or kidney transplant. Does America health care go by this guideline?

I begin dialysis when I think that dialysis will benefit my patient.  This is not based on any number, but rather , will dialysis improve the symptoms of my patient to the point that the patient is willing to undergo … Continue reading

Posted in Ask the Doctor, Dialysis, GFR, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

As a Nephrologist how high could you tolerate the serum creatinine number being before you would seriously consider dialysis or kidney transplant for a CKD patient?

As a nephrologist, I use the serum creatinine as an estimate of kidney function, but the decision to start dialysis requires that I listen to my patient and have them tell me what symptoms they are having and whether dialysis … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

Respected Doctor, I am an IT professional having Diabetes Type 2 since last 7 years. My recent blood report is as below – BS(F) 155, (PP) 147, HbA1c% 6.8% , Cr 0.9 , U Acid 6.5 , LDL – 122, HDL – 38, TG 202, SGPT 59, TSH 2.28, FT4 1.16, Hb 14.8 gm %, Urine Alb +++, FOH Urine Microalbumin Creatinine Ration 269.2 ug/mg Creatinine , Random Urine 107.35 mg/dl — — Jaffe rate IDMS Std. Urine Microalbumin (R) 28.90 mg/dl Yesterday , I went to an Endocrinologist – he prescribed me Amaryl MV1 (one tab before Breakfast and another one before Dinner). And he asked me to have a consultation of Nephrologist. I met with Nephrologist with Spot Urine ACR report – Nephrologist doctor prescribed me to take TAB KETOGRACE – 2 TAB TDPC. Before starting this medicine (KETOGRACE) – I would like to have your kind suggestion here . Currently I am taking only TAB Amary MV1 – one tab before Breakfast and another one before Dinner. I would be highly obliged if you kindly help me here. On getting your kind suggestion I will continue TAB KETOGRACE.

I am unable to recommend medical treatment without performing a complete history and physical examination.  I suggest that you follow the advice of your nephrologist.  

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Nephrologist

Is rituximab safe to treat Nephrotic syndrome in a 12 year old

I am an adult nephrologist and have never used Rituximab (Rituxan) in children.  I suggest that you consult with a pediatric nephrologist. For more information on Children’s health click here:

Posted in Ask the Doctor, Kidney-Related Health Questions, Nephrologist, Pediatric Issues, Pregnancy / Kids, Treatments

Hello, My 9 year old son recently had an renal ultrasound to look for kidney stones, etc. We don’t follow up with the nephrologist for over a month, and I’m curious about ultrasound report. The nurse told me on the phone that he didn’t have kidney stones, and this is what the report actually says: 1. Mild right pelviectasis in the prone position only (7 mm). 2. Otherwise normal sonographic appearance of the kidneys. No definite calcifications are seen. In the prone position only, there is mild right pelviectasis (SFU grade 1 bordering on 2) with AP diameter of the pelvis measuring 7 mm. I assume the pelviectasis isn’t serious since the nurse didn’t bring it up on the phone, but never having heard the term before, I tried to research it. The only references I can find refer to fetal pelviectasis, and I can’t find anything about this condition in a 9 year old child. I’m also curious about it only being seen in the prone position. Does this point to the possibility of some sort of blockage, or is it likely just a physiological finding? Is it unusual in a child his age?

Pelviectasis (also called pelvocaliectasis) merely means a separation of the collecting system or pelvis of the kidney detected by the ultrasound device.  It does not suggest any disease, unless there are symptoms or signs of blockage and none are described. … Continue reading

Posted in Ask the Doctor, Birth Defects/Urinary Tract Abnormalities, Blood/Urine Testing For Kidney Disease, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Pediatric Issues, Pregnancy / Kids

I’m a PD patient and my question is that every time I have a drain, I’m in severe pain my lower stomach. Is there something wrong?

In many cases, the pain is related to the catheter being sucked into the peritoneal lining of your abdomen.  In this case, I would slow the flow out of your abdomen until the pain clears.  If the pain persists, then … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

I am age 75, stage 4 ckd, on dialysis. I have lost my sense of taste for a 4 month duration. I have been unsuccessful in finding an answer for this. I am taking metoprolol, simvastatin, 81 mg aspirin, allopurinol, breo & ventolin. I am getting desperate with this taste issue. Thank you.

Taste alterations in dialysis patients are common, but very difficult to treat.  I can only suggest that you review your concerns with your nephrologist and determine if there is a problem with your dialysis treatments that could relieve the problem. … Continue reading

Posted in Ask the Doctor, Dialysis, Nephrologist, Symptoms and Side Effects, Treatments

I have stage 4 CKD and I now need a drug that’s safe to take for controlling my heart beat. The Duke hospital put me on Amiodarone HEL, 200 mg. Just a week I started a red rash on my body and legs so I will have to stop the drug. What other drug is safe to use? Thank you for you time and attendance to this request.

I am not a cardiologist and cannot recommend drug treatment without performing a complete history and physical examination.  There are other drugs that can be used, but this would depend on why Amiodarone was used and the heart disease they … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Treatments

Dear Doctor, My father (Age 67) is losing lot of protein through urine. He was suspected for Multiple Myeloma but his PET scan and bone marrow biopsy reports were absolutely normal. But the protein loss is still going on and that is causing him lot of weakness. We did his Kidney Functioning Test but that showed nothing serious. He was admitted to ICU because of some urine infection during which lot of water was accumulated in his body. He had swelling on his whole body which now is going away through diuretic medicines prescribed by his cardiologist. Is this related to Kidney or Blood?

Protein in the urine (known as proteinuria) is a finding in kidney disease.  It is first necessary to find out exactly how much protein is spilling into the urine.  If that protein loss is more than 3 grams per day, … Continue reading

Posted in Ask the Doctor, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Nephrotic Syndrome, Symptoms and Side Effects, Treatments

Good day. I live in West Africa and I suspect I might have kidney issues. I am sorry for writing, I know your organization operates in your country alone, but I am compelled to write, as we do not have such organizations over here. I have had series of tests conducted with fluctuating results, this coupled with strange symptoms have me very worried to the point of sickness. I lost my brother to ESRD in April last year, which was mostly due to scarring in his kidneys from unknown sources, as we have no family history of the disease. When my brother had a heart attack that led to his death, I attempted CPR, which was unsuccessful. A weeks days later I noticed I had become unwell and was prescribed ciprofloxacin by my doctor. Over time I noticed I urinated more often, never used to initially, but started waking once at night to urinate, had whitish sediments in my urine and felt a weird flowing sensation in my hands and legs, with Numbness/Pins and Needles also being experienced. Later I started having foamy urine which will go away on its own after some days. . . Has just started occurring again. Urinalysis always says no protein, blood or leukocytes. I am not diabetic or hypertensive either. I talked to my GP about it and he said nothing was wrong. But based on gut feelings I decided to go ahead and see a nephrologist who asked me to get a renal function test done. Since then I have had four Renal function tests + urinalysis done and one liver function test, a CT-scan and I am still confused about what is going on. Despite my urinalysis stating no protein repeatedly. Overtime, I have found that on ingesting any form of protein ( Egg whites,165 of milk, etc), my urine becomes very frothy for a day and its been giving me a lot of worries, my urine dipstick home test kit shows normal values, yet I am in doubt of its accuracy. Below is a list of my tests and results arraigned in chronological order. 21/07/2016 Sodium 140mmol/L Potassium 3.9mmol/L Bicarbonate: 27mmol/l Chloride: 101mmol/l Urea: 2.3mmol/L Creatinine 78umol/L Urinalysis: Perfect order No STI’s 02/09/2016 Sodium 138mmol/L Potassium 4.0mmol/L Bicarbonate: 30mmol/l Chloride: 102mmol/l Urea: 3.2mmol/L Creatinine 101umol/L Urinalysis: Perfect order No STI’s 15/11/2016 Sodium 137mmol/L Potassium 3.7mmol/L Bicarbonate: 28mmol/l Chloride: 98mmol/l Urea: 2.4mmol/L Creatinine 110umol/L Urinalysis: Perfect order No STI’s 26/01/2017 Sodium 137.2 mmol/L Potassium 3.2 mmol/L Bicarbonate: 20.6 mmol/l Chloride: 92.2 mmol/l Urea: 3.7 mmol/L Creatinine 168 umol/L Urinalysis: Perfect order No STI’s Doctor requested a re-run a week later 02/02/2017 Sodium 144 mmol/L Potassium 4.1 mmol/L Bicarbonate: 18 mmol/l Chloride: 109 mmol/l Urea: 1.66 mmol/L Creatinine 115 umol/L Urinalysis: Perfect order No STI’s Liver Function Tests Bilirubin(Total) 0.83mg/dl Bilirubin(Direct) 0.11 mg/dl Bilirubin(Indirect) 0.72 mg/dl SGOT(AST) 27.38 U/L SGPT(ALT) 21.79 U/L Alkaline Phosphatase 46.99 U/L GGT 30.78 U/l Total Proteins 7.6 g/dl Albumin 4.5 g/dl Globulin 3.10 g/dl A/G Ratio 1.45 g/dL I have attached a copy of the CT scan report for your perusal. Note, I am 6ft tall and weigh 72kg Thanks and have a great day Regards.

I am not able to make a diagnosis of chronic kidney disease based on the information that you present.  Your symptoms are not typical of kidney disease.  Because you have a family history of kidney disease, I suggest that you … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments, Urinary Tract Infection/Pyelonephritis