Category Archives: Treatments

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

Is Osmotherapy effective in the treatment of CKD?

I know of no use for Osmotherapy for any disease. Osmotherapy is not effective as a treatment of chronic kidney disease (CKD).

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

My husband had a kidney transplant in 2015.  Kidney as today is perfect but as a side effect, he is been losing mobility. He has been having a lot of pain in his legs and feet. The nephrologist doesn’t see anything abnormal.  We saw 2 neurology doctors and they were unable to see anything abnormal. What we can do? Where we can look for help?

I am unable to make a specific diagnosis based on the information that you present.  Leg and foot pain are not common symptoms of patients with a successful kidney transplant.  In most cases, a neurologist is the best person to … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions, Transplantation, Treatments

Back in October 2017 I was dx with Stage 4 Kidney Disease. I have other health issues along with a connective tissue disease known as Ehler’s Danlos Syndrome. On January 9, 2018 I go in and see the nephrologist and he called me later that day about my low numbers and to come in two days later to his hospital for biopsies.  I had severe pain and burning afterwards and continued until discharge the following evening. They did do an ultrasound and found nothing. I left with the continued throbbing and burning by my incision sight. Last weekend I became weaker and weaker as the pain worsened over the regular OTC Tylenol I was prescribed and the burning was worse. I ended up in the ER out by where I live. While in triage they did labs, a urine sample, and CT of my kidney’s and abdomen area. They found bleeding you would not have found from an ultrasound. My labs showed lower GFR since the biopsy, lower iron and potassium. I have been extremely dizzy and with many headaches I have passed out twice and fell once.  As for my preliminary labs results I was told it was either an allergic reaction/and or an infection to medication. I do not take and have not taken ibuprofen or advil type meds in about two years.  The nephrologist on the unit here is prescribing me steroids for two weeks, do labs and then meet with him. I have other daily meds but will the steroids be my only chance here? I can easily gain weight over anything or nothing. 

I am unable to provide recommendations about treatment without knowing the exact nature of your kidney biopsy and performing a complete history and physical examination.  Allergic disease in the kidney is commonly treated with steroids.  I do not have any … Continue reading

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

I was recently diagnosed with Primary FSGS tip lesion. I was placed on 60mg of Prednisone, along with Lasix, Lisinopril, and potassium. After consulting with my nephrologist and researching on my own, it is my understanding that tip lesion is quite rare and does not have a standard treatment protocol. My question to you is based on current research and information available what type of treatment and length of treatment would you recommend? If I were to seek a second opinion, what doctors in the U.S. have the best understanding about FSGS tip lesion?

Focal segmental glomerulosclerosis (FSGS) is a chronic scarring disease of the kidney and has five different pathological classifications including “tip lesion or variant”.  You are correct that there is no universally recognized treatment for FSGS. The most common treatment is … Continue reading

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

I am currently 24 weeks pregnant. My baby has been diagnosed with BMCDK. I am looking for a doctor who is willing to offer amnioinfusions and provide care with a result not ending in death of the fetus. If you can provide recommendations that would be amazing.

I will assume that the acronym BMCDK stands for Bilateral Medullary Cystic Dysplastic Kidneys.  This is a congenital disorder where both kidney are usually small, full of cysts and generally are not functional.  I am unaware of anyone performing such … Continue reading

Posted in Ask the Doctor, Birth Defects/Urinary Tract Abnormalities, Chronic Kidney Disease, Kidney Cysts, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Pediatric Issues, Pregnancy / Kids, Treatments