Category Archives: Nephrologist

My Dad has stage 4 kidney disease and lives in Atlanta. They have decided to have his arm prepared for likely dialysis. His kidney doctor told him it would probably be best to move near me for support. I live in Denver, a mile high. He has not had shortness of breath, but I understand that is a symptom of stage 4, which could come. He is anemic. What do you think about moving an 85 year old man in this condition to Denver? He does drive, travel, exercise, shop and cook still. His symptoms are he gets cold and itches. Is a blood transfusion an option for increasing red blood cells which would help with oxygen?

There are treatments for anemia if your father has a hemoglobin less than 10 grams per deciliter (gm/dl). Use of erythropoiesis stimulating agents (ESA’s) can be used to treat his anemia and kidney disease without administering a blood transfusion. You … Continue reading

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

My father who is 74yrs old, has a kidney stone that won’t pass. He is on blood thinners for a previous CVA 3 yrs ago and also has a small aneurysm. They want him to go off his blood thinners for the surgery. Last night they took him off the blood thinners and he had a TIA. So is there anything that can be done without going off them. Is it time too look for a second opinion? Thank you.

You ask a very complex question. Blood thinners are a very difficult treatment to manage and the decision to go off of blood thinners requires a consideration of the risk versus the benefit. The problem with the kidney stone is … Continue reading

Posted in Ask the Doctor, Kidney Stones, Kidney-Related Health Questions, Medication and Kidney Function, Nephrologist, Urological Issues

My mother and I both have Nail-patella syndrome and the fatal part of it is kidney failure. My mom was just diagnosed with stage 4 chronic kidney disease and also AKI. Her creatinine levels are a 3.0 and I wanna know is she gonna have to start dialysis? I’m at a stage 2 at 34 and she’s 74. With Nail-patella syndrome, there’s nothing you can do to stop the progression. It is just part of the syndrome. So how quickly will it advance? She’s all I got left and I’m worried sick.

Nail-patella syndrome is a congenital (you are born with the disease) kidney disease that is associated with abnormalities of the finger nails, knee caps and malformed bones in the arms and legs. Some individuals also have abnormalities of hearing and … Continue reading

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

My 88 year old grandfather has stage 3b CKD but is otherwise in good health besides suffering from high blood pressure. He is presently taking Diovan/HTC 80/12.5 mg, Monopril 5 mgs and finally Amlodipine 5mgs. His personal physician wants to increase his BP meds because he found it too high on his last checkup. Given the fact my grandfather takes Diuretics, ARB’s, ACE’s and CCB’s each with its own mechanism of action. What category would be the best choice to increase in order to safeguard his kidney? I have heard that Ramipril (=Monopril?) is the best choice. Also his kidney specialist has prescribed Sodium Bicarbonate 500 mgs x 3. Could the salt content in these pills be contributing to the increase in BP? Thank you for all your great work!

Diovan (Valsartan) is an angiotensin receptor blocker (ARB).  Monopril (Fosinopril) is an angiotensin converting enzyme inhibitor (ACE-I).  I do not recommend the use of both an ARB agent and an ACE-I agent for blood pressure control in patients with chronic … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Medication and Kidney Disease, Nephrologist

I have an enlarged prostate. I have limited my fluid intake to avoid urinating so often. Some weeks ago, I thought I pulled a muscle in my lower back, it turns out that it is my left side kidney that is hurting from being dehydrated. My question: is my kidney going to repair itself and stop hurting or have I damaged the kidney permanently. Thanks for your help.

The problem that you mention is a urological problem. A urologist is a surgeon and deals with diseases of the prostate. I am a nephrologist and would suggest that you discuss your problem with a urologist. If the prostate problem … Continue reading

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

When is it decided that dialysis is needed? Stage 4 is the number I was given – what does that mean? Dialysis was said I needed and I chose in the gut. How long can I be on this until a transplant is needed?

The decision to start dialysis is based on a discussion between you and your nephrologist. It is not based on any number or stage. When your symptoms become significant and dialysis is felt to benefit those symptoms, dialysis is often … Continue reading

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

Hello Dr. Spry, My sister is 38 years old and was diagnosed with congenital CKD about 10-15 years ago. Up until that point, she had frequent UTIs and did not know the cause. The frequency and severity of kidney infections led to her diagnosis. She has been suffering with this and treated for VUR, including several stint surgeries, only for her symptoms to return a few months after each one. The specialists she has seen aren’t used to treating VUR in adults. With the frequency and severity of her pain and infections (she’s almost constantly on different antibiotics), do you have any recommendations for treatment or maybe a competent specialist you could recommend in our state? It would mean so much to see her receive effective treatment and relief. Thanks.

The problem that you describe is a urological problem. I am a nephrologist and deal only with kidney issues. I am not a surgeon and do not deal with the urinary tract. Hence, your sister should be consulting with a … Continue reading

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

Hi Sir, My son at age 2.8 year, before a week did sonography. They got to know, left kidney larger than right kidney. Left kidney size (92 MM) & Right kidney size (72 MM) and when born his left portion big as compare right side. Please give any suggestion, is there any future problem will face ? Any treatment require?

I am an adult nephrologist and do not see children or infants. I suggest that you consult with your pediatrician and ask for an interpretation of the ultrasound.  In most individuals, the right kidney is slightly larger than the left. … Continue reading

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

My brother has congestive heart failure and stage 5 renal failure. He was told 2 days ago he is positive for C/Diff and has been on Flagyl twice a day since yesterday Feb. 24. He is scheduled to have a port on Feb 27th. I have been told he will have to wait until the infection is gone by the PA but the MD said he could go on and have the port because the infection is in the intestines and wouldn’t be a problem? He is very weak and has difficulty with breathing. He has only 10% function of kidneys. I am concern the infection could spread if he goes on dialysis and if he waits until infection is gone his kidneys may shut down and he will not survive. My brother is 65 years old.

Placement of a hemodialysis catheter or a peritoneal dialysis catheter should not present a problem for someone with a Clostridium Difficile (C. Diff) infection. I suggest that your brother review the surgical plans with his nephrologist and make sure he … Continue reading

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

I have Stg 4 CKD; a transplant is approx 4 months away. However, I have recently had bouts of gout in my lower extremities. Took prednisone, but it remains, and periodically flares up. Is it safe to take tart cherry and celery seed to bring Uric acid levels down? Those levels currently at 14.5 to 16. Watching diet doesn’t seem to help. Thanks.

There are medications such as Febuxostat (Uloric) and Allopurinol (Zyloprim) that lower the serum uric acid levels and effectively treat gout. Use of these agents with low dose colchicine can be very effective in patients with gout and chronic kidney … Continue reading

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