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Diabetic and hypertensive. Ultrasound done. Suspected for possible chronic pyelonephritis. Is this serious?

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General & Family Physician
Practicing since : 2001
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my wife aged 44 is a diabetic and hypertensive for the past 12 years. Our recent ultra sound report revealed that "small for size left kidney (7.7 x 4.1 cms) with loss of parenchymal thickness and scarring at upper pole- suggest possible Chronic Pyelonephritis". What does this mean? how to deal with the case? how serious is the case? Please find readings of other examination for your information

Her fasting blood sugar is #147, urine sugar is nil, Post lunch sugar is 110, post lunch urine sugar is--nil blood urea is 19serum creatinine 0.7, sodium 137, potassium 4.7, Chloride 98, Total cholestral--152; HDLCholestrol-43; LDL Cholestrol--75; VLDL Cholestrol-- 34; Triglycerides---168; Cholestrol /HDL Ratio---3.5
Posted Sat, 2 Mar 2013 in Kidney Conditions
Answered by Dr. Michelle Gibson James 1 hour later
Hi, thanks for using healthcare magic

Pyelonephritis is infection of the kidney and the radiologist states that the appearance of the kidney is suggestive of repeated and prolonged episodes of kidney infection.
Repeated infections can cause scarring and a decrease in the size of the kidneys. Kidney disease with chronic changes cannot be reversed but it would be important to prevent further damage to this kidney and any damage to the right kidney.
Most persons can survive with one functioning kidneys, this is the reason for kidney transplants but it is important, especially with diabetes and hypertension to prevent any more damage.

At present based on the creatinine level that you have quoted the kidneys are functioning normally.To further assess kidney function your doctor may check for leakage of protein in the urine and determine the GFR level.GFR stands for glomerular filtration rate and it lets the doctor know how effectively the kidneys are working. It is used to assess prognosis.

To reduce the risk of further damage it would be important to quickly and effectively treat any infections , to control the diabetes and hypertension.
Blood pressure should be maintained at 130/80 or less, this is the goal for diabetics and persons with kidney disease.

The blood sugar goals are a post meal of 180 are less, so her value is good and a fasting or premeal blood sugar between 72 and 126. The HbA1c which is also required to assess blood sugar control and done every 3 months- should be less than 7%. It may be important to look at the carbohydrate intake in the evenings which would affect the fasting sugars, in addition the medication used on the evening may need to be addressed.

The cholesterol levels are excellent.

i hope this helps, feel free to ask any other questions
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Follow-up: Diabetic and hypertensive. Ultrasound done. Suspected for possible chronic pyelonephritis. Is this serious? 44 minutes later
I am giving some more details for your information, please answer. Also tell me is it a critical stage and how to handle the case

Her Glycosylated Haemoglobin is 9.2 and complete urine examination (CUE) is as follows:

Physical examination:

colour--pale yellow
specific gravity--1.025

Chemical examination:

protein --- trace--- negative
glucose----negative ----negative
blood ---negative----negative
urobilinogen----normal---0.2-1.0 mg/dl
leucocytes----present (+)---negative
bile salts---negative---negative

Microscopic examination (per HPF)

Leucocytes ---12-15---2-3
RBC -------nil--------nil
Epithelial cells---8-10---3-5
other -------nil-----nil

Answered by Dr. Michelle Gibson James 1 hour later

The HbA1C is high at 9.2, this implies that the blood glucose control is not optimal.If it is not improved then it would impact on the kidneys. As stated this should be less than 7.

To improve diabetes and reduce the chances of kidney disease she should (1) be on an ACE or ARB for her hypertension- these are kidney protective drugs
(2) examine the diet to find ways of reducing carbohydrate intake-look at the bread/biscuit/pasta/pastry/rice/potato/breakfast cereal intake to see if these can be decrease which would decrease the blood sugar
(3)limit the use of sodas and fruit juices and use mainly water

IF these are done and medication used appropriately and the blood sugar and HbA1c levels remain high, it may be necessary to alter the diabetic medication. Diabetes is a progressive disease and medication often has to be increase so that the levels can be controlled.

The urinalysis results do not show any abnormalities.

Please feel free to ask anyother questions
Above answer was peer-reviewed by
Follow-up: Diabetic and hypertensive. Ultrasound done. Suspected for possible chronic pyelonephritis. Is this serious? 8 hours later
Dr. XXXXXXX Gibson James,

Thank you very much for your inputs. Perhaps your feedback enabled me to work out a plan to address the case. Could you please suggest me a diet plan given her health condition and particularly in Indian context.

Thanks a lot and appreciate your lucid explanations and patience.
Answered by Dr. Michelle Gibson James 10 hours later

In general diabetics are recommended to reduce their carbohydrate intake and increase the intake of vegetables ,fruits and lean meats.
Foods which are high in carbohydrates are breads (such as nan breads, rotis), reduce the use of flour (there are different types such as white, rice, chickpea,gram), rice (white or brown basmati) and also reduce any pastas that may be used.

You may want to consider, if possible, asking your doctor for a referral to a nutritionist for in depth advice on dietary management.

Please feel free to ask anything else
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