I have been taking 50 mg of Atenolol once a day for many years. Today I had my first telephone conversation from the nurse/kidney specialist from my insurance company and she recommended that I take Metoprolol instead because it was less risky for my CKD. (I also take Hydralazine 75 mg 2x a day and Losartan 50 mg 2x daily.)

Atenolol is a very long acting Beta Blocker medication that becomes more long acting when kidney disease is present. It does not injure kidneys but the dose may have to be adjusted as your kidney function declines. Metoprolol is a more short acting Beta Blocker and may not require dose adjustment as your kidney function declines.

The decision to change this medication should be made by your primary care physician or your nephrologist, as they are more aware of your overall medical situation and can advise you as to if this is appropriate for your particular situation.  

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function, Nephrologist | Comments Off on I have been taking 50 mg of Atenolol once a day for many years. Today I had my first telephone conversation from the nurse/kidney specialist from my insurance company and she recommended that I take Metoprolol instead because it was less risky for my CKD. (I also take Hydralazine 75 mg 2x a day and Losartan 50 mg 2x daily.)

My wife has been told that she can not have vascular access. What’s next?

I am not sure of the circumstances associated with your wife’s kidney illness. If your wife is not able to have vascular access then she may be a candidate for peritoneal dialysis. Peritoneal dialysis requires a tube be placed in the abdomen and does not require vascular access. I suggest that you discuss alternative forms of dialysis with your wife’s nephrologist.  

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist | Comments Off on My wife has been told that she can not have vascular access. What’s next?

Hi Dr., since I had a kidney stone stuck in my ureter and had to wait months for surgery, I suddenly overnight developed severe heart palpitations which I am now on Beta blockers for approximately 15 months now. Could the stone have caused the heart palpitations and damage to the kidney?

I do not know of any link between kidney stones and heart palpitations. Certainly the pain associated with a kidney stones, can lead to stress and cause an increase in blood pressure as well as an increase in heart rate. I am not sure that this would cause an arrhythmia of the heart.  

Posted in Ask the Doctor, Hypertension/High Blood Pressure, Kidney Stones, Kidney-Related Health Questions, Symptoms and Side Effects | Comments Off on Hi Dr., since I had a kidney stone stuck in my ureter and had to wait months for surgery, I suddenly overnight developed severe heart palpitations which I am now on Beta blockers for approximately 15 months now. Could the stone have caused the heart palpitations and damage to the kidney?

Doctor, nice to say hello. I would like to know which is the best food for me as I am a chronic kidney patient, with a glomerular filtration rate <19 and creatinine of 3.20, white rice or brown rice? Doctor and I would like to know what are renal parenchymal changes? And if it is curable or serious? Thank you God bless you and all kidney patients.

For someone with Stage 4 chronic kidney disease (CKD) and an estimated glomerular filtration rate (eGFR) of less than 19 milliliters per minute per 1.73 meters squared, it is not possible to recommend a specific diet without knowing all of your medical history and knowing your full laboratory testing. I do recommend a low salt diet where you avoid any extra salt in the diet. Otherwise, you will need to consult with your physician or a dietitian who can assess your current nutritional status and review your current laboratory studies, in order to properly make dietary recommendations. 

“Renal parenchymal changes” is a common phrase used to discuss changes that are seen on ultrasound examination. It most commonly describes a loss of tissue water and scarring that occurs on the surface of the kidney and indicates a loss of glomeruli, which are the individual filters of the kidney. This description is not a specific diagnosis but rather a common finding in all patients with loss of kidney function. Treatment depends on the cause of the CKD.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diet/Nutrition, GFR, Kidney-Related Health Questions | Comments Off on Doctor, nice to say hello. I would like to know which is the best food for me as I am a chronic kidney patient, with a glomerular filtration rate <19 and creatinine of 3.20, white rice or brown rice? Doctor and I would like to know what are renal parenchymal changes? And if it is curable or serious? Thank you God bless you and all kidney patients.

I am 33 years old. Should I be worried based on these numbers??? Note, I made sure to be well hydrated for the most recent test. Also, should I discontinue use of Valacyclovir and Allopurinol which was started in July 2021? Here are all the numbers: Serum Creatinine: 1.43 in 2019, 1.40 in July 2021, 1.43 in September 2021. BUN: 17 in 2019, 15 this month. BUN/Creatine ratio: 12 in 2019, 10.4 this month. All urinalysis came back in normal ranges. No protein in urine.

I am unable to make a specific diagnosis based on the information that you present. These numbers could be normal depending on your body size and muscle mass. I am unable to recommend medication without performing a complete history and physical examination. Valacyclovir and Allopurinol doses should be adjusted to your kidney function. I suggest you discuss this with your primary care physician.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function | Comments Off on I am 33 years old. Should I be worried based on these numbers??? Note, I made sure to be well hydrated for the most recent test. Also, should I discontinue use of Valacyclovir and Allopurinol which was started in July 2021? Here are all the numbers: Serum Creatinine: 1.43 in 2019, 1.40 in July 2021, 1.43 in September 2021. BUN: 17 in 2019, 15 this month. BUN/Creatine ratio: 12 in 2019, 10.4 this month. All urinalysis came back in normal ranges. No protein in urine.

Hello, I recently had blood work done that showed my GFR is 57 and would like additional information on kidney disease. I showed positive for Albumin in my urine and have taken extremely high doses of NSAIDS for over 30 years. I am a white female, age 53 years old and am not happy with my internal medicine doctor just calling it a sluggish kidney. I have flank pain, malaise, shortness of breath walking from room to room, cold a lot, extreme itching all over primarily on my back, insomnia, nausea, heart palpitations, extreme muscle weakness and fatigue/pain in them. I need a Nephrology doctor, don’t I? Thank you so much. 

I am unable to make a specific diagnosis based on the information that you present. The use of Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) in high doses for many years can cause chronic kidney disease (CKD). If that is the case, stopping the NSAID’s and remeasuring your kidney function in six months would be indicated. I am not able to explain the rest of your symptoms as related to CKD. If your primary care physician is unable to make a specific diagnosis as to the cause of your CKD, then referral to a nephrologist would be appropriate. I suggest further discussion with your primary care physician (PCP) regarding your concerns.

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function, Nephrologist | Comments Off on Hello, I recently had blood work done that showed my GFR is 57 and would like additional information on kidney disease. I showed positive for Albumin in my urine and have taken extremely high doses of NSAIDS for over 30 years. I am a white female, age 53 years old and am not happy with my internal medicine doctor just calling it a sluggish kidney. I have flank pain, malaise, shortness of breath walking from room to room, cold a lot, extreme itching all over primarily on my back, insomnia, nausea, heart palpitations, extreme muscle weakness and fatigue/pain in them. I need a Nephrology doctor, don’t I? Thank you so much. 

My father who is 72 has been in the ICU for Covid related complications since August 2. He has been sedated most of the time but is now more lucid. During the time in ICU, he became a dialysis patient as well. Prior to becoming ill, he was a very strong and physically healthy person who walk/jogged 50 miles per week and lifted weights. He was on seroquel and Welbutrin for his mental health challenges (bi-polar and anxiety). His doctors do not want to put him back on the Wellbutrin, they say for kidney reasons. Now that he is more lucid, he is crying all the time. He cannot speak because he has a trach now. He will be transferred to an LTAC setting next week. I want to know your recommendations for his mental health meds now that he is on dialysis. The ICU doctors don’t seem to worry too much about it because it isn’t “emergent” but he has a long way to go in rehab and being mentally prepared, or at least not crying continually, will be important. For now, they are giving him Valium to keep him calm.

I am not a mental health professional and I am not able to recommend medical therapy without first seeing the individual for a complete history and physical examination. I have taken care of many patients coming out of the Intensive Care Unit (ICU) and I would agree that limiting new medications is very important because of complications of delerium and confusion occur commonly in patients that have been in the ICU for prolonged periods of time.  

If you have expressed your concerns to the physicians caring for your father, you might want to ask if your father is being seen by a mental health professional. It is true that his kidney status will complicate the medications that can be used.

Posted in Ask the Doctor, COVID-19, Dialysis, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function | Comments Off on My father who is 72 has been in the ICU for Covid related complications since August 2. He has been sedated most of the time but is now more lucid. During the time in ICU, he became a dialysis patient as well. Prior to becoming ill, he was a very strong and physically healthy person who walk/jogged 50 miles per week and lifted weights. He was on seroquel and Welbutrin for his mental health challenges (bi-polar and anxiety). His doctors do not want to put him back on the Wellbutrin, they say for kidney reasons. Now that he is more lucid, he is crying all the time. He cannot speak because he has a trach now. He will be transferred to an LTAC setting next week. I want to know your recommendations for his mental health meds now that he is on dialysis. The ICU doctors don’t seem to worry too much about it because it isn’t “emergent” but he has a long way to go in rehab and being mentally prepared, or at least not crying continually, will be important. For now, they are giving him Valium to keep him calm.

Hello. I’m sending this question because I haven’t been able to get any help from anyone and every day is really hard. I really need to get some help soon. I believe what I have is distal RTA. My urine pH is always above 8.5, I have hyperchloremia; was hospitalized for hypokalemia before and my calcium is frequently high. When my kidney was very bad while I was taking aspirin, I was drinking 2 gallons of water a day and peeing 2-3x. My circadian rhythm was completely flipped and I could only sleep when the sun came up. And my skin was so dry it hurt and I’d get dry patches. There’s a lot more but I’ll keep it short. Every day is really hard and trying to guess what the issue is (high calcium, low potassium, low sodium) is really exhausting. Every doctor referred me to a nephrologist and I finally saw one after waiting for months but he wouldn’t listen to me and only focused on the fact that I drank a lot of water. I told him multiple times it was better now but when I drank a lot I only peed 2 or 3 times. The third or fourth time I said this he was surprised and went wait, you didn’t pee a lot? He thought I just drank a lot and peed a lot and wouldn’t listen to me. I tried telling him about my acidosis symptoms (pungent acetone breath, sudden muscle fatigue, so tired I can’t even watch TV, random panic, intense thirst and dryness) and he told me it was GERD. I said it wasn’t because I’ve had GERD and this is different because of the pungent ketone breath. He just ended the appointment then and brought me to the receptionist to make another one. Out of every health problem or issue I’ve had in my life this one is really the hardest. I feel like I can’t get help from anyone at all. It is really really really painful. Please help. Thank you.

Your symptoms do not suggest a Renal Tubular Acidosis (RTA) to me. Most patients with RTA have no symptoms at all and this is discovered on routine testing of blood and urine. A distal RTA can be associated with hypercalcemia in some patients with Sarcoidosis but this is very uncommon. In most cases, you should be having kidney stones in that situation. I am not able to link the low sodium to any of these diseases. The low potassium can be linked to a distal RTA, but your blood bicarbonate level should be low as well in addition to a high blood chloride level.  

I am sure this is why the nephrologist was unable to come up with a link to RTA. I can only suggest continued follow up with your physician. In some cases, repeated testing and follow up is the only way to make a definitive diagnosis.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney Stones, Kidney-Related Health Questions, Nephrologist | Comments Off on Hello. I’m sending this question because I haven’t been able to get any help from anyone and every day is really hard. I really need to get some help soon. I believe what I have is distal RTA. My urine pH is always above 8.5, I have hyperchloremia; was hospitalized for hypokalemia before and my calcium is frequently high. When my kidney was very bad while I was taking aspirin, I was drinking 2 gallons of water a day and peeing 2-3x. My circadian rhythm was completely flipped and I could only sleep when the sun came up. And my skin was so dry it hurt and I’d get dry patches. There’s a lot more but I’ll keep it short. Every day is really hard and trying to guess what the issue is (high calcium, low potassium, low sodium) is really exhausting. Every doctor referred me to a nephrologist and I finally saw one after waiting for months but he wouldn’t listen to me and only focused on the fact that I drank a lot of water. I told him multiple times it was better now but when I drank a lot I only peed 2 or 3 times. The third or fourth time I said this he was surprised and went wait, you didn’t pee a lot? He thought I just drank a lot and peed a lot and wouldn’t listen to me. I tried telling him about my acidosis symptoms (pungent acetone breath, sudden muscle fatigue, so tired I can’t even watch TV, random panic, intense thirst and dryness) and he told me it was GERD. I said it wasn’t because I’ve had GERD and this is different because of the pungent ketone breath. He just ended the appointment then and brought me to the receptionist to make another one. Out of every health problem or issue I’ve had in my life this one is really the hardest. I feel like I can’t get help from anyone at all. It is really really really painful. Please help. Thank you.

I’m on my second transplant, 2001 and 2017. I’ve had so many years on transplant meds. I suffer with severe anxiety and depression pretty regularly. I’m wondering if my transplant meds, particularly tacrolimus, are contributing to this? If so are there other viable options that are as effective?

Tacrolimus is associated with a fine hand tremor that can make you think you are anxious but I am not aware that these drugs precipitate anxiety or depression. Many of my patients with transplant have been very anxious and depressed during the pandemic because of the greater risk for infection and concerns about exposure in public. This has certainly been an issue for my transplant patients. I suggest that you visit with your transplant nephrologist about this issue and see if professional help may help. There are many good treatments for anxiety and depression but consultation with a mental health professional may be necessary.

Posted in Ask the Doctor, COVID-19, Kidney-Related Health Questions, Medication and Kidney Function, Transplantation | Comments Off on I’m on my second transplant, 2001 and 2017. I’ve had so many years on transplant meds. I suffer with severe anxiety and depression pretty regularly. I’m wondering if my transplant meds, particularly tacrolimus, are contributing to this? If so are there other viable options that are as effective?

Hi. I have had a few blood tests recently and I am wondering if I should be concerned with a GFR of 88? I am a 35 year old female. Also is bilateral hydronephrosis hereditary? Can an adult have it and not know it?

The normal value for an estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per minute per 1.73 meters squared. Hence, your eGFR is normal. It is possible to have bilateral hydronephrosis and have it discovered incidentally during a screening ultrasound examination as an adult. It is important that this finding be reviewed with a Urologist to make sure it does not require treatment.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, GFR, Hydronephrosis and Hydroureter, Kidney-Related Health Questions | Comments Off on Hi. I have had a few blood tests recently and I am wondering if I should be concerned with a GFR of 88? I am a 35 year old female. Also is bilateral hydronephrosis hereditary? Can an adult have it and not know it?