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High BP, heart attacks, high urea and creatinine. Given saline. Done angiography. Why?

Hi, my father is 58 yrs old. 15 days ago, he got a minor heart attack. His BP raised above 200. Then it suddenly dropped to unrecorded limit, that time he shifted to ICU. Even saline is also given through neck. Doctor suggested an Angiography.
Before doing angiography, he undergone for some test. In Test result, creatinine and urea are found high. Doctor suggested to wait for few days. But now even after 8 days creatinine is above 1.5.
What could be the problem ? Whom to consult, to nephrologist or cardiac ? Is there any major problem can caused if we wait for few more days ?
Asked On : Sun, 21 Apr 2013
Answers:  3 Views:  52
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Cardiologist 's  Response
Hello Ms. Shweta
Thanks for writing to us.
Angiography might have been planned because of the heart attack he suffered.
Since we give a dye (ink) in angiography which it self can cause kidney damage, especially in old, female, diabetic subjects who already have compromised kidney functions (as suggested by a creatinine of above 1.5mg% in case of your father), your doctors advised to hold angiography for a while. The possible cause of damage to kidney is high blood pressure in your case. there are many other causes like diabetes, drugs etc.
Now you need to consult both the specialists; cardiologist and nephrologist. Cardiologist will tell you about the necessity of doing an angiography in your father, its advantages and disadvantages. Nephrologist will tell you how to prevent further damage to kidneys, and if you chose to get an angiography done, then he will be taking care that the damage to kidneys by angiographic dye is reduced to minimum and if any damage occurs to kidney during angiography he will be available to manage.
i hope i cleared the scenario to you. feel free to discuss further.
sukhvinder singh
Answered: Sun, 21 Apr 2013
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Internal Medicine Specialist Dr. Akhilesh Dubey's  Response
Welcome to HCM,
Your father is having coronary artery disease and a minor attack and admitted to hospital and due to episode of hypotension or shock he was monitored in ICCU it must be cardiogenic that is why coronary angiography is to be done.
When patient is in unstable hemodynamic state we need to monitor CVP( Central venous pressure) to guide for fluid replacement, do not worry about that as it is just cannula in jugular vein.
It is possible due to various causes or hypotension caused compromised kidney function what is called pre renal Azotemia.
Angiography may be postponed if no real emergency because kidney functions as we need to used contrast dyes may cause kidney damage, it is wise to delay angiogram and it can be done when kidney function returns to normal.
If creatinine is 1.5 mg/dl it is just borderline so do not worry it is Cardiologist who will do angiography and angioplasty with stent .
Hope every thing goes fine and he recovers soon.
Take care
Good Luck.
Answered: Sun, 21 Apr 2013
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Internal Medicine Specialist Dr. Omer's  Response
your father had heart attack with cardiac failure that led to kidney failure
heart is a pump and without pump kidneys will fail due to decrease blood supple to them from heart
improving your father pump that is heart by dobutamine and CRT will decrease urea and creatinine.
so cardiologist is the priority not the nephrologist as he wont do dialysis as heart is the culprit of kidney failure not kidney.
Answered: Sun, 21 Apr 2013
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