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What Does Fluctuation In Creatinine Level Indicate?
Question: Last year my father suffered a mild heart attack and Sodium deficiency.The angiography was done and the reports have been attached.The doctor suggested that there is no need of stent and the medical therapy was suggested.He is on following medicines:
1) LOSAR 50 & CARCA 12.5 TWO TIMES A DAY
2) NITROFIX 20 TWO TIMES A DAY
3) DEPLATT A ONE TIME
4) ORVAS20 ONE TIME
6) HALF LASIX,LIVOGEN AND HALF FRUSELAC
We are doing tests(CBC,Lipid Profile) on regular basis.Recently he suffered from sore throat and fever and doctor suggested to conduct kidney tests as well and his latest test has shown an increase of creatinine levels and Blood Urea Nitrogen.Last time we did Kidney profile was one year before and Creatinine was 0.95 but now we have done tests and the reports have been attached
1) One test was done after having Nitrofix and creatinine levels were 1.9 few 4 days back and today again we have done tests but this time without any medicine and on fasting and the levels were 1.6
Please suggest the way forward.Are the kidneys have been impacted and what should we do now
1) LOSAR 50 & CARCA 12.5 TWO TIMES A DAY
2) NITROFIX 20 TWO TIMES A DAY
3) DEPLATT A ONE TIME
4) ORVAS20 ONE TIME
6) HALF LASIX,LIVOGEN AND HALF FRUSELAC
We are doing tests(CBC,Lipid Profile) on regular basis.Recently he suffered from sore throat and fever and doctor suggested to conduct kidney tests as well and his latest test has shown an increase of creatinine levels and Blood Urea Nitrogen.Last time we did Kidney profile was one year before and Creatinine was 0.95 but now we have done tests and the reports have been attached
1) One test was done after having Nitrofix and creatinine levels were 1.9 few 4 days back and today again we have done tests but this time without any medicine and on fasting and the levels were 1.6
Please suggest the way forward.Are the kidneys have been impacted and what should we do now
Brief Answer:
Consult a nephrologist
Detailed Answer:
Dear Madam
1. A change of 0.3 mg% in creatinine levels in 3 days is usually not real. This usually happens because of technical reasons. Any infection at this age may also lead to rise in creatinine which usually comes back to normal after control of infection. This may take few days to few weeks. Anyhow 1.6mg% is suggestive of some renal insufficiency. Especially in comparison to 0.95 mg% it is significant. His hemoglobin of 9.8 gm% is also low and may be an indicator of renal insufficiency. For exact status of kidneys, better method at this age is to calculate glomerular filteration rate (GFR). There are various tests designed to ascertain GFR.
2. Since he has coronary artery disease, Loss of cardiac pumping (usually measured as ejection fraction by ECHO) may also contribute to renal insufficiency. However, going through the history of questions you have asked at HCM about your father, it seems his ejection fraction was normal till last ECHO. An ECHO is indicated if last ECHO was not done in recent past and was normal.
3. I would recommend a consultation with a nephrologist to access his kidney status. Two basic things in management of kidney insufficiency are maintaining adequate hydration and avoiding medicines which are harmful to kidneys. Among these drugs "pain killers" are most common drugs. Diuretics like LASIX may also have bad effect on kidneys. Hence his prescription also requires revision. Do consult a nephrologist as well as his cardiologist.
Sincerely
Sukhvinder
Consult a nephrologist
Detailed Answer:
Dear Madam
1. A change of 0.3 mg% in creatinine levels in 3 days is usually not real. This usually happens because of technical reasons. Any infection at this age may also lead to rise in creatinine which usually comes back to normal after control of infection. This may take few days to few weeks. Anyhow 1.6mg% is suggestive of some renal insufficiency. Especially in comparison to 0.95 mg% it is significant. His hemoglobin of 9.8 gm% is also low and may be an indicator of renal insufficiency. For exact status of kidneys, better method at this age is to calculate glomerular filteration rate (GFR). There are various tests designed to ascertain GFR.
2. Since he has coronary artery disease, Loss of cardiac pumping (usually measured as ejection fraction by ECHO) may also contribute to renal insufficiency. However, going through the history of questions you have asked at HCM about your father, it seems his ejection fraction was normal till last ECHO. An ECHO is indicated if last ECHO was not done in recent past and was normal.
3. I would recommend a consultation with a nephrologist to access his kidney status. Two basic things in management of kidney insufficiency are maintaining adequate hydration and avoiding medicines which are harmful to kidneys. Among these drugs "pain killers" are most common drugs. Diuretics like LASIX may also have bad effect on kidneys. Hence his prescription also requires revision. Do consult a nephrologist as well as his cardiologist.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Please see details
Detailed Answer:
Dear Madam
1. The ECHO report shows no previous damage to heart/ heart valves. It has normal pumping capacity. Hence it is not contributing to renal damage.
2. To understand the treatment opted for a particular disease, we have to understand the mechanism of disease and benefits of treatment being offered. Till date, the international consensus is to do angiography and put a stent in patients with acute coronary syndromes (heart attacks) only. Those patients who have exertional angina (chest pain or discomfort on exertion/exercise only) have equal benefits from medical therapy/ stents. If they continue to have debilitating angina despite optimal medical therapy, they may be subjected to stenting. Hence it depends upon the patients symptoms as well as on tempo of symptoms. People may have problems even after stenting. They may develop block at same site or other sites. Their stents may get blocked suddenly.Your cardiologist must have given consideration to your father's age, daily routine, symptoms and other co-morbidities before choosing a treatment option. Stents are not straight away, sure-short treatment for blockages, as projected by many.
Sincerely
Sukhvinder
Please see details
Detailed Answer:
Dear Madam
1. The ECHO report shows no previous damage to heart/ heart valves. It has normal pumping capacity. Hence it is not contributing to renal damage.
2. To understand the treatment opted for a particular disease, we have to understand the mechanism of disease and benefits of treatment being offered. Till date, the international consensus is to do angiography and put a stent in patients with acute coronary syndromes (heart attacks) only. Those patients who have exertional angina (chest pain or discomfort on exertion/exercise only) have equal benefits from medical therapy/ stents. If they continue to have debilitating angina despite optimal medical therapy, they may be subjected to stenting. Hence it depends upon the patients symptoms as well as on tempo of symptoms. People may have problems even after stenting. They may develop block at same site or other sites. Their stents may get blocked suddenly.Your cardiologist must have given consideration to your father's age, daily routine, symptoms and other co-morbidities before choosing a treatment option. Stents are not straight away, sure-short treatment for blockages, as projected by many.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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