5 months back, I had a kidney stone operation of the right kidney and I find that right kidney is functioning 9 ℅ and left kidney is functioning 42℅. Now after 5 months, I have very bad pains in my right kidney seems very heavy. Bad smell in the urine. What should I do? I have already gone thru surgery twice of my right kidney. Please help.

The problem that you describe is a urological problem and I am a nephrologist.  I do not perform surgery.  You should consult with your urologist.

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Posted in Ask the Doctor, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing, Treatments, Urological Issues

I understand the kidneys functions are to remove toxins from the blood. This will probably sound like a very strange question, however, I have no one else to ask. If someone has injected themselves with bacteria and instead of causing an abscess it gets absorbed, does that mean that bacteria gets filtered through the kidney, and can that cause a kidney infection? Can the kidney infection then lead to cysts (which have recently shown up on ultrasound) and if so, are they likely to be considered “simple” or polycystic? Also, this person is currently being treated for kidney infections and psychiatric disorders.

Bacteria in the blood can cause infection in the kidneys, but I am not sure this will lead to cysts in the kidney.  Bacteria in the kidney causes acute pyelonephritis and this typically results in scars in the kidney rather than cysts.  I am unable to make any specific diagnosis based on the information that you provide.

 

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

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.

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

I was born with one kidney so I tend to pay close attention to its health. My main concern is after exercising I develop proteinuria and I prove this by using the urine-analysis strips. Depending how intense the exercise was, it will determine the protein level in my urine, for example after doing lots of heavy weight lifting, I have seen protein levels as high as 60-100 mg/dL. So with that is the exercise induced proteinuria going cause my kidney function to fail prematurely or lead to kidney issues? Am I more susceptible to exercised induced proteinuria with only having one kidney?

Exercise induced protein in the urine (proteinuria) is also known as orthostatic proteinuria.  If the protein disappears from your urine with rest and after sleeping all night, then this is likely normal.  Some children have this finding and grow out of it, however, if your have persistent protein in the urine after being supine and resting, this is should be further investigated by your physician.  I suggest that you have a urine protein test (not a dipstick, but rather a test of urine protein to creatinine ratio) done after you empty your bladder before going to bed and then provide a sample of urine for testing on arising in the morning.  If this test is normal, then I don’t believe this is a serious problem.  I suggest further consultation with your physician.

 

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

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.  I am unable to interpret the kidney ultrasound without performing a complete history and physical examination on your son.  I suggest that you ask the nephrologist when you meet with him or her in the future.

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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

Have three queries for transplant patients 1. When bp is never constant and it goes up when one goes for morning walk or for that matter any physical movement results in bp number. If this is true then why patients are advised to keep blood pressure within a range of 120 to130/80 to 90. Is there any range for max and min after physical exercise. How much mental anxiety or stress impacts BP? 2. Cholesterol reducing medicine mostly statin is prescribed for the patients. Does intake of this medicine for long period of time affect the kidney? 3. Should patients plan volume and timing for this water intake for the day? Thanks doc as always.

The standard way to take blood pressure is to take the blood pressure sitting for 5 minutes.  Exercise and physical activity increase the blood pressure and this is normal.  The normal blood pressures that you quote are for 5 minutes sitting comfortably in a chair with your arms at rest.  You should not take your blood pressure until you rest if you use the normals that you quote.  Statins do not have any ill effects as long as they are monitored.  Statins can cause muscle injury in some individuals that can affect kidney function, however, statins have also prevented heart attacks in kidney patients.  This is why they are used.  Water intake can be at any time and the kidney can handle the water intake whenever it is.

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Posted in Ask the Doctor, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Medication and Kidney Disease, Medication and Kidney Function, Treatments

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 you may need further testing and consultation with your nephrologist.

 

 

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.  In some cases, I have sent patients to a dentist to review the dental and mouth problems that could be contributing to altered taste sensation.

 

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 are trying to treat.  The cardiologist may have to consult with your nephrologist about the proper dosing and use of other potential drugs.

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