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Undergone Urology Operations For Pelvic Lipamatosis And Augmentation Cystoplasty. Noticed Creatinine Level Is 4.1. What To Do?
Question: Hello doctor,I earlier consulted you regardingmy Hypertension in June2013,I am a Stage4 kidney patient and I had undergone urology operations in 2008 &2009 for Pelvic lipamatosis and Augmentation cystoplasty(urinary bladder augmentation)respectively.Now,my creatinine level is 4.1 and most of the time I am on a pipe(indw),elling catheter) or for brief periods of time on CIC(self catheterisation) to avoid /minimise infections possibililty(viz.frequent infections of E.coli) I had been visiting a local nephrologist regularly earlier and he had prescribed DYTOR, LOSAR ,CINOD(clinidipine)tablets to me but though BP is somewhat under control now, SWELLING in feet and legs has started.. Then I went to another local nephrologist for opinion and he prescribed Thyronorm 25,SOBISIS(500mg thrice) and Febuxostat40mg once, for reducing swelling and forBlood pressure ProlometXL50 (Twice) now my pulse rate has fallen to 51 and BP is also not steady, My recent Lab tests indicate : 24hrs creatininine clearance 12ml/min and 24 hrs urinary protein 1534mg, Serum creatinine 4.1 , Potassium 5.3 and Sodium 142. Kindly reassess the entire medication for me and suggest appropriate medicinies/dosages for me .My goal is 1)To reduce S.Creatinine 2)To control BP and 3) To reducre swelling of my legs and feet.An early reply is solicited. Also,if I require Dialysis in future, for how long it may be possible to postpone the same?
Brief Answer:
these steps may help you
Detailed Answer:
hi XXXXX,
the goal of treatment which you should understand are--
BP as close to 130/80 as possible.
Decrease incidence of urine infection- by proper technique of CIC, Surveillance for infection by repeated urine routine every month to see for pus cells and early treatment of any urine infection.
Dialysis is needed if you have breathing trouble, poor appetite, worsening serum creatinine, or high potassium levels.
1)To reduce S.Creatinine . stoping losar may reduce creatinine. control BP and any infection. with this creatinine will come down to best possible, which in your case may be between 3 to 4.
2)To control BP . you are on losar, clinidepine and prolomet . Prolomet can reduce heart rate , if < 60 you need to stop it or at least reduce dose under supervision of your doctor. Clinidepine is good can go upto 10mg two times a day. losar may not be a good choice for you and may have to be done away with. now what you can add to control BP is prazocin XL (minipressXL) or Clonidine ( arkaminine) in your treatment and increase there doses slowly till your bp is 130/80. all this has to be done under monitoring of your doctor.
3)To reduce swelling of my legs and feet.- Dytor is the only tablet in your treatment which will reduce swelling. you can increase upto 40 mg twice a day under guidance of your doctor. but also decrease your fluid intake ( water tea and other liquids) to less than 1 litre /day. So in you take less and more comes out swelling will go away. decrease salt in diet.
hope this answers all your questions .
best wishes.
these steps may help you
Detailed Answer:
hi XXXXX,
the goal of treatment which you should understand are--
BP as close to 130/80 as possible.
Decrease incidence of urine infection- by proper technique of CIC, Surveillance for infection by repeated urine routine every month to see for pus cells and early treatment of any urine infection.
Dialysis is needed if you have breathing trouble, poor appetite, worsening serum creatinine, or high potassium levels.
1)To reduce S.Creatinine . stoping losar may reduce creatinine. control BP and any infection. with this creatinine will come down to best possible, which in your case may be between 3 to 4.
2)To control BP . you are on losar, clinidepine and prolomet . Prolomet can reduce heart rate , if < 60 you need to stop it or at least reduce dose under supervision of your doctor. Clinidepine is good can go upto 10mg two times a day. losar may not be a good choice for you and may have to be done away with. now what you can add to control BP is prazocin XL (minipressXL) or Clonidine ( arkaminine) in your treatment and increase there doses slowly till your bp is 130/80. all this has to be done under monitoring of your doctor.
3)To reduce swelling of my legs and feet.- Dytor is the only tablet in your treatment which will reduce swelling. you can increase upto 40 mg twice a day under guidance of your doctor. but also decrease your fluid intake ( water tea and other liquids) to less than 1 litre /day. So in you take less and more comes out swelling will go away. decrease salt in diet.
hope this answers all your questions .
best wishes.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Sir, my doctor told that Losar will help in reducing urinary protein (1534mg at present); Is there any alternative drug to losar for urinary protein regulation? (in case Losar is stopped).Also, I want to know why Sobisis(500mg) and Febutaz 40mg tablets are prescribed by the other doctor and whether they are really necessary alongwith my BP treatment? If so, for how long period of time they are required to be taken? Also, I had initially started on Prazosin(RenopressXL5mg) but once I fell unconscious and hence discontinued the same and the doctor then suggested ProlometXL50 twice a day.Now, can I once again start PRAZOSINXL on a minimum dose of 2.5 mg ?
Brief Answer:
queries answered
Detailed Answer:
hi XXXXXX,
Your doctor is right. losar will reduce proteinuria. so we have to balance the effect and side effect. if your creatinine has been rising in last 2 months ,say it was 3.0 a month or 2 back and now came 3.5 and then 4.0 , so it is not stable and increasing in that situation you have to stop losar. but if creat was 4.0 6 month back and now also 4.0 you can continue it. but you have to see creatinine every month if it further increases you have to stop losar anyway.
Proteinuria is not too much, so don't worry.
Sobisis is sodium bicarbonate. need can be established by doing ABG test and see bicarbonate level- if less than 22 sobisis to be given - no relation to BP.
febutaz is for uric acid control. see blood level and decide no relation to BP.
Actually if bp is high and we have to start minipress 2.5 mg can be started under guidance of your doctor. with bp monitoring.
In the end i would say that clinical judgement of the treating doctor is most important in prescribing the treatment to the patient.
thanks
queries answered
Detailed Answer:
hi XXXXXX,
Your doctor is right. losar will reduce proteinuria. so we have to balance the effect and side effect. if your creatinine has been rising in last 2 months ,say it was 3.0 a month or 2 back and now came 3.5 and then 4.0 , so it is not stable and increasing in that situation you have to stop losar. but if creat was 4.0 6 month back and now also 4.0 you can continue it. but you have to see creatinine every month if it further increases you have to stop losar anyway.
Proteinuria is not too much, so don't worry.
Sobisis is sodium bicarbonate. need can be established by doing ABG test and see bicarbonate level- if less than 22 sobisis to be given - no relation to BP.
febutaz is for uric acid control. see blood level and decide no relation to BP.
Actually if bp is high and we have to start minipress 2.5 mg can be started under guidance of your doctor. with bp monitoring.
In the end i would say that clinical judgement of the treating doctor is most important in prescribing the treatment to the patient.
thanks
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. Chakravarthy Mazumdar
Answered by
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