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Hello Doctor, My Son Had Hep C For Many Years We Found Out That He Has Hypertension Now We Are Very Nervous What To Do?
Question: Hello Doctor,
My son had Hep C for many years. All blood tests were good, including creatinine which increased over the years within baseline.
Last year we found out that he has hypertension (about 140/09) GP did stress test, ultrasound investigation, all ok.
On March 28, 2018 we went to liver clinic for annual check up, all blood tests are ok, creatinine 114, my son was clinically well. They informed us that new treatment for his genotype is ready and we can start in May.
We went to clinic on May 02, 2018 to start our treatment by Zepatier. Blood tests was ok, creatinine 13. I called clinic and ask if this treatment will affect creatinine and what is going on. They advised to start the treatment and come next day to repeat cr and lytes.
On May 03, 2018 we repated cr and lytes. In one day cr went up, 135
We continued treatment and finished with success on July 25, 2018
Cr was jumping up and down:
Mar 28 114
May 02 131
May 03 135
May 08 128
May 16 117
May 23 120
May 30 112 XXXXXXX 27 130
July 25 128
Gfr was jump and down from 77 to 67
No treatment was done for kidneys, blood pressure and proteinouria during Hep C treatment.
Abdomen ultrasound is normal.
bp 140/149-95/105
Urine analysis (24 hours collection) shows protein 4.29 g/cp on May 10, 2018
Urine analysis (24 hours collection) 2.39 g/cp on July 27, 2018
Nurse said that this is a good signs, kidneys start recovery.
On July 25, 2018 completed blood tests. Cr was 128 (stable), K+ 5.4 (stable)
On August 03, 2018 they started treatment for bp. Ramipril 5 mg once a day.
My son took first tablet on August 03 and bp dropped to avr. 128/88, we were so happy!
On Aug 04 bp avr 133/90
On Aug 05 bp avr 134/91
On Aug 5 bp avr 135/93
On Aug 06 bp avr 136/96
On Aug 07 morning avr 135/90, daytime avr 135/88
I checked his bp before we take new dose 177/113, he took one table and we run to hospital in emergency. After 2 hours 163/106, after 4 hours 153/103
in emergency blood work was done, lytes are ok (except bicarbonate, little dropped), cr 151!!! in 5 days of taking medication???
We have appointment in gn clinic on September 20, 2018, long time to wait!
Emergency referred to general specialist and booked appointment on August 10
I am very nervous!!! Please help!!!
My son had Hep C for many years. All blood tests were good, including creatinine which increased over the years within baseline.
Last year we found out that he has hypertension (about 140/09) GP did stress test, ultrasound investigation, all ok.
On March 28, 2018 we went to liver clinic for annual check up, all blood tests are ok, creatinine 114, my son was clinically well. They informed us that new treatment for his genotype is ready and we can start in May.
We went to clinic on May 02, 2018 to start our treatment by Zepatier. Blood tests was ok, creatinine 13. I called clinic and ask if this treatment will affect creatinine and what is going on. They advised to start the treatment and come next day to repeat cr and lytes.
On May 03, 2018 we repated cr and lytes. In one day cr went up, 135
We continued treatment and finished with success on July 25, 2018
Cr was jumping up and down:
Mar 28 114
May 02 131
May 03 135
May 08 128
May 16 117
May 23 120
May 30 112 XXXXXXX 27 130
July 25 128
Gfr was jump and down from 77 to 67
No treatment was done for kidneys, blood pressure and proteinouria during Hep C treatment.
Abdomen ultrasound is normal.
bp 140/149-95/105
Urine analysis (24 hours collection) shows protein 4.29 g/cp on May 10, 2018
Urine analysis (24 hours collection) 2.39 g/cp on July 27, 2018
Nurse said that this is a good signs, kidneys start recovery.
On July 25, 2018 completed blood tests. Cr was 128 (stable), K+ 5.4 (stable)
On August 03, 2018 they started treatment for bp. Ramipril 5 mg once a day.
My son took first tablet on August 03 and bp dropped to avr. 128/88, we were so happy!
On Aug 04 bp avr 133/90
On Aug 05 bp avr 134/91
On Aug 5 bp avr 135/93
On Aug 06 bp avr 136/96
On Aug 07 morning avr 135/90, daytime avr 135/88
I checked his bp before we take new dose 177/113, he took one table and we run to hospital in emergency. After 2 hours 163/106, after 4 hours 153/103
in emergency blood work was done, lytes are ok (except bicarbonate, little dropped), cr 151!!! in 5 days of taking medication???
We have appointment in gn clinic on September 20, 2018, long time to wait!
Emergency referred to general specialist and booked appointment on August 10
I am very nervous!!! Please help!!!
Brief Answer:
Please see the detailed answer .
Detailed Answer:
HI,
First of all I feel so sorry for the hard times you have been rough recent.
It's great that you have provided good details of the case. I would answer your question in few points .
1. This was good that he received the treatment for his HCV And I hope he would be cured now because of the effective therapy .but this would be great if you get a viral PCR done to be sure about it if not eady done .
2. Regarding his rise in crt with ramipril , that's not unexpected and is normal at the moment .Let me explain it , Ramipril belongs to group called ACE inhibitor , and with its use we expect that upto 20 to 30 percent of drop in kidneys function may occur normally ( this is how it works to control bp and protect kidney ) howe'ver the drop in function ( hence rise in crt) should not be more then 30 percent of baseline .In yours case the crt has gone to 151 from 128 which i consider to be with in the 30 percent lemit so at the moment that's not worrisome but we need to keep an eye if it still rises we need to stop the drug .Thats you can chek in your next appointment.
3.ramipril (and all ACE inhibitors ) is important drug in people with protinurea( protin in urine ) as is yours case.
4 .The BP should be well controlled talk to our doctor in next appointment he may be adding drug or increasing dose to control BP.
Howe'ver the most important point I want to discuss is that why his renal function are abnormal? I mean What is the causes of his raised creat and lot of protien in urine ??Did any doctor tell u something ?? that is necessary because there are a lot of causes of such problem in a young man and many of them are pretty treatable and may lead to complete kidney failure in some cases.So If not already known , I would strongly advse you should have a consultation with a nephralogist( specialist in kidney diseases) to know exactly what's wrong with his kidneys and if it can be treated .
Hopes I have answered your question. Still if you have any question to ask , please don't hesitate to ask. I will be glad to answer.
Kind Regards
Dr Rahman
Please see the detailed answer .
Detailed Answer:
HI,
First of all I feel so sorry for the hard times you have been rough recent.
It's great that you have provided good details of the case. I would answer your question in few points .
1. This was good that he received the treatment for his HCV And I hope he would be cured now because of the effective therapy .but this would be great if you get a viral PCR done to be sure about it if not eady done .
2. Regarding his rise in crt with ramipril , that's not unexpected and is normal at the moment .Let me explain it , Ramipril belongs to group called ACE inhibitor , and with its use we expect that upto 20 to 30 percent of drop in kidneys function may occur normally ( this is how it works to control bp and protect kidney ) howe'ver the drop in function ( hence rise in crt) should not be more then 30 percent of baseline .In yours case the crt has gone to 151 from 128 which i consider to be with in the 30 percent lemit so at the moment that's not worrisome but we need to keep an eye if it still rises we need to stop the drug .Thats you can chek in your next appointment.
3.ramipril (and all ACE inhibitors ) is important drug in people with protinurea( protin in urine ) as is yours case.
4 .The BP should be well controlled talk to our doctor in next appointment he may be adding drug or increasing dose to control BP.
Howe'ver the most important point I want to discuss is that why his renal function are abnormal? I mean What is the causes of his raised creat and lot of protien in urine ??Did any doctor tell u something ?? that is necessary because there are a lot of causes of such problem in a young man and many of them are pretty treatable and may lead to complete kidney failure in some cases.So If not already known , I would strongly advse you should have a consultation with a nephralogist( specialist in kidney diseases) to know exactly what's wrong with his kidneys and if it can be treated .
Hopes I have answered your question. Still if you have any question to ask , please don't hesitate to ask. I will be glad to answer.
Kind Regards
Dr Rahman
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you, Doctor Rahman!
Yes, we checked hep C after 4 and 12 weeks therapy. Virus is not detected. Next final check up for hep C will be in October ( 12 weeks after finish therapy).
We booked appointment with nephrologist. The earliest date is September 20, 2018. We are willing to perform biopsy and find out what cause the proteinuria and cr increase and treat and/or slow down any kidney issues.
I change ramipril intake from 5 mg once per day to 2.5 mg twice a day.
Bp stays in 130/125- 93/88
We will check blood for cr and lytes on August 20 after 2 weeks of treatment.
Nurse in hepatology department who works with us thinks that issue with kidneys are based on long term hep C infection in the body.
I am very nervous!
Thank you,
Aytan
Yes, we checked hep C after 4 and 12 weeks therapy. Virus is not detected. Next final check up for hep C will be in October ( 12 weeks after finish therapy).
We booked appointment with nephrologist. The earliest date is September 20, 2018. We are willing to perform biopsy and find out what cause the proteinuria and cr increase and treat and/or slow down any kidney issues.
I change ramipril intake from 5 mg once per day to 2.5 mg twice a day.
Bp stays in 130/125- 93/88
We will check blood for cr and lytes on August 20 after 2 weeks of treatment.
Nurse in hepatology department who works with us thinks that issue with kidneys are based on long term hep C infection in the body.
I am very nervous!
Thank you,
Aytan
Brief Answer:
Your concern is very right , but things look hopefull.
Detailed Answer:
HI aytan great to hear of you back.
You are are right, I can understand your concern ; anyone would have been nervous in such condition.howe'ver things are done very rightly and I am hopeful for the best..
Great that the virus is cured.
Yes hep C is one causes of such type of kidney probelm called nephrotic syndrome but that's not very common and is already cured. I think there are other causes as well and biopsy is the best answer here . I am hopeful as many causes of nephrotic syndrome are manageable .
Ramipril is genrally advised once , however untI'll BP is controled and renal functiins do not go much worse ( ie more then 30 percent ),then it's Ok .
I appreciate your efforts and my best wishes with you people .
Lets hope for the best .
Please feel free to ask me anything else regarding this.
Your concern is very right , but things look hopefull.
Detailed Answer:
HI aytan great to hear of you back.
You are are right, I can understand your concern ; anyone would have been nervous in such condition.howe'ver things are done very rightly and I am hopeful for the best..
Great that the virus is cured.
Yes hep C is one causes of such type of kidney probelm called nephrotic syndrome but that's not very common and is already cured. I think there are other causes as well and biopsy is the best answer here . I am hopeful as many causes of nephrotic syndrome are manageable .
Ramipril is genrally advised once , however untI'll BP is controled and renal functiins do not go much worse ( ie more then 30 percent ),then it's Ok .
I appreciate your efforts and my best wishes with you people .
Lets hope for the best .
Please feel free to ask me anything else regarding this.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Answered by
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