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Dr. Andrew Rynne

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Are elevated serum creatinine level and reduced platelet count in a person under treatment for the IgA nephropathy worrisome?

Answered by
Dr.
Dr. Ravi Bansal

Nephrologist

Practicing since :1996

Answered : 345 Questions

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Posted on Wed, 9 Jan 2019 in Kidney Conditions
Question: I am 57 and have IGA nephropathy for the past 8 years which is being treated with Cardace 10 mg, Minipress XL 5 mg, Lipitor 10 mg, and fish oil capsules. I had an ultrasound in XXXXXXX 2017 which showed normal kidneys. In addition I have a benign prostrate (Grade 1) - no medication. BP is around 130/80.
My recent test results in FEB18 are as follows:
1. Routine urine examination -no protein or blood noticed ( test in August 17 showed protein as Trace, blood nil)
2. Total cholestrol - 144 mg/dl
3. Serum Creatinine 1.3 mg/dl (lab range 0.72-1.25 mg/dl). Earlier this was 1.2 mg/dl for the past 2 years, different lab - range value 0.5-1.2 mg/dl.
4. My platelet count has been historically low varying from 128,000 - 150,000, the latest test shows a platelet count of 116,000.
5. BUN (blood urea nitrogen) -16.3 mg/dl
6. PSA - 1.05 ng/ml
7. Albumin in urine - 68.6 mg/L with ACR at 98.18 ug/mg
I am concerned as the creatinine which was 1.2 mg/dl for the past 1.5 years (I test every 6 months, lab range 0.50-1.2 mg/dl) has increased to 1.3 mg/dl in the FEB18 test (test done in a new Lab - range value is 0.72- 1.25). Also my platelet count continues to be below the range.
I would appreciate your views on the above in terms of whether there is any cause for concern or I continue current medication. I exercise daily for about 45 minutes
doctor
Answered by Dr. Ravi Bansal 1 hour later
Brief Answer:

No. There is no cause of concern.

Detailed Answer:

Hi,

You are on conservative management of IgA nephropathy. You do not have any protein or RBC in urine. I feel your disease is very well controlled and there should not be any concern.

As far as creatinine is concerned, definitely it is borderline at upper limit of normal but this can be because of previous disease injury.

You just need to keep BP in control. Limit your protein intake to 0.8gm/Kg/day. Avoid red meat.

Avoid painkillers and any protein supplements.

This will keep your Kidneys protected for long times.

Hope I have answered your query. Let me know if I can assist you further.

Regards,

Dr. Ravi Bansal
Nephrologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ravi Bansal 17 hours later
Thank you for your reassuring reply. I have a few follow up queries.

1. What is the upper limit for serum creatinine - in some labs upper limit is 1.2 mg/dl, some at 1.25 mg/dl and I have read on the internet that upto 1.3 mg/dl is considered ok. My concern for creatinine is that it was 1.2 mg/dl for about 4 years till Dec17, and now in Feb18 is it 1.3 mg/dl.

2. Given my current creatinine levels at 1.3 mg/dl -at what level of creatinine should I be concerned about having more aggressive treatment of IGA?

3. I took Vitamic C 500 mg for 2 tablets per day for 2 days prior to my blood test as a preventative for catching a cold as some family members had a cold. Does Vitamic C increase creatinine levels?

4. My urine protein and blood has varied for the past 7 years from Nil to ++. My test in April 2017 showed protein and blood at + each. In August 17 it showed Trace for protein and Nil for blood, and now in Feb 18 it showed Nil for both. Does protein and blood in urine fluctuate so much?

5. Grateful for your comments on the level of platelets which is below the minimum at 116,000. It was 100,000 in April 17, increased to 122,000 in August 17 and is now in Feb18 at 116,000. The lab comment for Feb18 was that
" due to presence of platelet clumps, actual count may be higher than he automated count. Suggest fresh repeat citrate sample for an exact count, if clinically indicated".

Thanks and regards
doctor
Answered by Dr. Ravi Bansal 25 hours later
Brief Answer:

Don't panic -all answers below.

Detailed Answer:

Hi!

1. Serum creatinine is a reflective estimate of kidney function. It is not a good estimate though. But it can be easily done and repeated.

Glomerular filtration rate is a better estimate- a normal person will have a GFR of 100ml/min. When this GFR falls to around 60 ml/min serum creatinine starts to rise. So a normal serum creatinine does not rule out kidney disease.

Also the creatinine level depends on how muscular you are. A healthy muscular male adult will have a higher normal then a weakened male adult even with same level of kidney function.

So don't go after the creatinine alone. Just see if there is rising pattern on monthly testings. That is a better estimate than any one single value.

2. Treatment of IgA is ongoing and it is not directly related to the creatinine level. It is more related to amount of protein in urine and number of RBC in urine.

3 Vitamin C can increase serum creatinine. Repeat test after 2 weeks of stopping vit C.

4. Yes these values will keep on fluctuating that is why you need repeated checkup.

Hope I have answered your query. Let me know if I can assist you further.

Regards,

Dr. Ravi Bansal
Nephrologist

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ravi Bansal 58 minutes later
Thank you fo your comments.

1.Please provide your comments on item 5 regarding platelet count.

2. Does Glomerular filtration rate take into account both serum creatinine and urea (BUN)? Based on the serum creatinine of 1.3 mg/dl and age 57, eGFR is 60, whereas with inclusion of BUN, the eGFR works out to 63.

Thanks
doctor
Answered by Dr. Ravi Bansal 27 hours later
Brief Answer:

Please see detail answer

Detailed Answer:

Hi!

If your platelet counts remain always in range of 100000 to 150000 then it could be effect of any past infection (mostly viral) or use of medications.

But rarely it may be part or hematological disorders especially if your spleen is also enlarged. In any case they are in the same range and don't show a progressive decline- there is nothing to worry.

GFR 60 or 63 - there is not much difference as such these are calculated formula which use creatinine alone or with urea also.

Accurate GFR can be measured by Isotope GFR method (DTPA). But that is usually not required in day to day management of patients.

What is more important is the trend of GFR. Suppose you test the GFR by same method every month and you find that it is progressively falling over next 3 to 4 months then we should try to find a reason for it.

Hope I have answered your query.

Regards,

Dr. Ravi Bansal
Nephrologist
Above answer was peer-reviewed by : Dr. Nagamani Ng
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