Category Archives: Symptoms and Side Effects

Symptoms and Side Effects

I have polycystic kidney disease and have recently begun dialysis. Once I completed the first treatment I went home and soon after began feeling tremors and vibrations all over my body. It lasted until one in the morning. After the following treatment, and after every subsequent treatment, it has lasted from 4-6 hours. No one has been able to tell me why this is occurring and whether or not it will eventually stop. Will this have any effect on my muscles or tissues if prolonged, and can you tell me why this is occurring? I’m a white female, age 77.

I am unable to make a specific diagnosis based on the information that you provide. During your dialysis treatment, the machine may be cooling you to some extent and this could be causing you to shiver. I find it unusual … Continue reading

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

I am one of the caregivers for my 79 year old father. He is Type 2 diabetic and started dialysis in Dec 2016 via AV fistula graft in upper right arm. In February, my father fell, broke his clavicle. He was in a rehab facility during his recovery. He started struggling with confusion, nausea (during and after dialysis), extreme cramping even hours to next day after dialysis and overall weakness. We discovered at that time that the dialysis center was continuously decreasing his dry weight to remove edema in his feet. They were trying to get him to 98 kilos (which is where he was in the fall) and after a Z-scan they discovered he was actually at 100k. They decided he was actually dehydrated and the problems got better and pretty much went away after they adjusted for the higher dry weight. My dad is generally what you would call the ideal dialysis patient. His facility sends home monthly reports of protein and calcium levels and such. Other than being low in protein, his numbers that are monitored are right in the middle the target zone. He says the nurses set him up and leave him alone because he doesn’t present any problems during treatment. We don’t know if this is normal or bad nursing. In the last 5-6 weeks the edema in his legs/feet has increased and the nausea has returned. The nausea is in the form of dry heaves, generally no stomach fluid and happen within 8 hours of dialysis. He has told me that he’s felt nauseated during dialysis and told the nurses he was cramping so they would adjust the machine. He said telling them about cramping got more attention than feeling sick. My family spoke to this doctor yesterday. His dialysis doctor keeps trying to decrease his dry weight to get the fluid out of his feet but it brings on the nausea. Her only response was we have to get the water out of his feet and that being on dialysis only offers poor quality of life and this was as good as he was going to get. We tried talking to his general doctor, she refers us back to the dialysis doctor. We tried talking to the nephrologist he used to see prior to dialysis and they refer us back to the dialysis doctor. We are considering taking him to a different facility, but are we just jumping from one hot pan to another? We have no idea who else to speak to or who to ask for help. No one will talk to us and the current dialysis doctor is not helping at all. Thus this email. Today he had an EKG, chest x-ray and carotid artery ultrasound done so see if there are other problems. My dad really struggled with dialysis in the beginning as it was an emergency start. But he finally settled into a routine and generally did well. He would be tired and sleep for about 1 hour afterwards and then perk up and be fine in between treatments. Since this trouble with dehydration, edema and nausea started since February, he can’t even walk out of treatment (needs a wheelchair) and can barely function between treatments. We know dialysis is an extremely hard way of living. We know that our dad is 79 years old and that adds its own set of complications. But is it really a disease that you just barely exist until your next treatment? Are we in a bad facility and need to move or is this just the way it is? Or is dialysis really just a disease that is like putting a band-aide on a severed leg? I know you can’t really answer some of these questions but how can we get help?

In some cases, it is necessary to be persistent. You and your family have the right to attend a multidisciplinary conference that is held about your father once per month at the dialysis facility. I suggest that you contact the … Continue reading

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

Recently my Dr. ordered some blood work to determine my general health. I had not had any blood work done in 18 months. I am 88 years old and other than high blood pressure (135 or 140 over 70) and atypical glaucoma (low pressures) have no problems. She wanted to rule out diabetes 2 as this is a familial disease. I feel I am in excellent health. In our recent appt. she said my kidneys were at 43 and should be 60. I do not know what this meant. I asked her to explain but she ignored my question, mumbling something about not been critical. I have never been much of a water/tea (NO coffee) drinker, but I urinate 2-3 times a day at the most I drink juices and canned drinks without sugar and juices (orange, grapefruit, tomato, etc.) I am almost 89 and function well, driving my own car, playing duplicate bridge etc. I wear a pad liner for protection in case I have to urinate quickly and can’t get to a bathroom on time, but this seldom happens.

Kidney function has a tendency to decline with aging.  Hence, beyond age 40, there is a loss of about 1% of kidney function (as estimated by glomerular filtration rate or eGFR).  At your age, you would be expected to have … Continue reading

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

I am 73 y.o, 5’6″ weigh 140 lbs exercise 1-2 hours daily with weights and jogging. I have GFR of 57 last tested summer of 2015. My primary suggested I not worry. My blood labs, creatinine and ??? are normal. No protein in urine. I have been taking protein powder in shakes probably every or every other day which include avacodo, greens, nuts, coconut or almond milk, hemp seed, flax seed but now I am afraid to include protein powder so often and think I will cut down to twice weekly. I have read to take less protein, less dairy, less caffeine and I’ve seen renal diet including more veggies, fruits and grains. I am intolerant of gluten and have controlled HBP taking 20 mg Quinipril daily. Over the holidays, my BP went up and I am going to go back to 40 mg which I was on but HPB was very good and I decreased my dose with my Primary MD’s approval. If you have any suggestions or concerns to tell me I will be grateful. Thank you.

You are taking very good care of yourself.  I am not an advocate for protein restriction in patients with chronic kidney disease (CKD).  I do advocate for the DASH diet.  You can learn more about the DASH diet at:  https://www.nhlbi.nih.gov/health-topics/dash-eating-plan  

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

Is there a recommended procedure to reduce kidney damage due to iodine based contrast agents used for CT scans. I have a single kidney and my latest GFR is 52. I have scans every 6 mo as follow up for stage 3a clear cell renal carcinoma. If you can point me to a current technical paper that would suffice.

The most important thing to do is see if contrast dye is needed to make a diagnosis with the computerized tomogram (CT) scan.  If the CT scan can be done without contrast and yield good information, then this should be … Continue reading

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

I wanted to know about the best treatment option available for Polycyctic kidney disease.How effective is the surgery option? Can a cyst of size exceeding 3.5 cm be operated upon?

Surgery on the cysts of a patient with polycystic kidney disease (PCKD) should rarely be necessary and has generally been abandoned as a treatment for patients with PCKD.  I would recommend that your blood pressure should be very carefully controlled, … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Polycystic Kidney Disease, Symptoms and Side Effects, Treatments

My mom has been on dialysis for over 5 years. She has 4 to 5 aneurysms in her arm. Is this possible with just 1 fistula in her arm?

The aneurysms of a fistula are related to repeated needle puncture of the skin and vein of the fistula.  This creates weakness or thinning in the wall of the fistula and the skin.  This tends to create the aneurysms that … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions, Symptoms and Side Effects

I have been diagnosed with stage 3 kidney disease. My nephrologist says I don’t need to change my diet until I reach stage 5/dialysis. I would appreciate your response and reason.

For Stage 3 chronic kidney disease (CKD), I am a strong advocate for the low sodium DASH diet.  You can review the DASH diet at:  https://www.nhlbi.nih.gov/health-topics/dash-eating-plan. For Stage 4 CKD, it may be necessary to modify the diet based on … Continue reading

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

My father is 74 years old this year. He is at end stage renal failure. He has had kidney diseases for slightly more than 10yrs and have been on medication and lifestyle change to slow down the deterioration of his kidney. He is not overweight and neither does he have diabetes. He is on hypertension medication for as long as he had the kidney disease. Recently, his serum creatinine shot up from 900 to 1800 and had started to be symptomatic. He feels very weak and having problems to eat, drink or even stand. He’s now admitted and the nephrologist started him on hemodialysis daily to bring down the waste in his body. What I want to ask is whether hemodialysis or peritoneal dialysis is a better choice (in terms of survival rate or life expectancy) for elderly patients above 70 years old? If it was your father (you being the nephro), which would you recommend?

The decision between hemodialysis and peritoneal dialysis is one of lifestyle difference rather than one of survival or life expectancy.  Hemodialysis can be done at home or in-center and has several different modes of delivery but is most commonly done … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, GFR, Kidney-Related Health Questions, Nephrologist, Symptoms and Side Effects, Treatments

I am a 61 year old female who has sustained damage from 25 years of lithium treatment. Although no longer on any such medication since 2003, my GFR is 53 and my creatinine 1.1 which I maintain through an abstemious diet. Concomitant with this damage, I my bladder has hypertrophied to contain over 2,000 ml due to having withheld the urge to urinate in order neither to arrive late to myriad adjunct teaching assignments, nor to leave the classroom. I have, consequently, lost control over my bladder and now wear diapers pads which I routinely soak (such that the urine rolls down my legs, into my shoes, and ultimately onto the floor) several times per day. Are there any physicians who might be able to ameliorate my situation, possibly even either to reverse, or to repair this damage? I have read that lithium damages the renal tubules’ ability to be sensitive to aquaporin. If this is so, is there either an analog or a means through which an exogenous administration of aquaporin, similar to that of insulin for diabetics, available.

I know of no way to repair the damage done to your bladder.  I am a nephrologist and have no expertise in bladder diseases.  Diseases of the bladder and lower urinary tract are within the expertise of a urologist.  Hence, … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments, Urinary Tract Infection/Pyelonephritis