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For how long Inj.Espogen is to be continued? How to control kidney damage, BP and blood sugar?

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1.     How much long the Inj. Espogen 3000 IU is to be continued as it's availability is very difficult and my Doctor insist to come over his far distance placed Clinic at the every month interval and thereupon, he only says to continue with this Medication along with Inj. Espogen 3000 iu.
2.     Whether rest of the above stated Medication is to continue for Blood Sugar, Blood Pressure and How to control over Albumin / Protein & Creatinine as well as Kidney Damage.
     As Now my father is not complaining about letharginess, his Sugar Level and BP is also in control, except a little bit complaint of Weighty feeling in Chest. He also come back to his routine of Morning Walk of 2-3 Km.
Posted Sun, 6 May 2012 in Kidney Conditions
Follow-up: For how long Inj.Espogen is to be continued? How to control kidney damage, BP and blood sugar? 18 minutes later
     Known Diabetic, since the year 1992.
     Hypertension (High Blood Pressure) since more than last five-six years.
     No Habit of Liquor, Smoking etc.
     Pure Vegetarian, Early Riser and generally prefer controlled diet for Diabetics. Life Long Sport person and continued playing Badminton up to February, 2005 till his retirement from High Court, Allahabad. Since then, Regular Morning - Walk of 4 to 5 Km. and Half-an-hour Yoga every day, which was stopped since August, 2011 due to Extreme Letharginess / weekness, pain in legs, unwillingness of leaving Bed but now again has been started after relief about the same.
     Problem of Prostate diagnosed in the year 1999, Laser-Operation was done in SGPGI, Lucknow.
     Conventional Medication for Blood Sugar and Blood Pressure continued on the advice of SGPGI, Lucknow.
     Thereafter, Conventional Medication for Blood Sugar and Blood Pressure continued on the advice of Nazareth Hospital, Allahabad.
     Problem of Hypoglycemia occurred in the year 2009 for two-three times.
     Problem of early sign of Parkinson Decease, for which medicine was prescribed by KGMC Medical, College.
     Problem of Prostate re-occurred in XXXXXXX 2010, TURP was done in K. K. Hospital, Lucknow in July, 2010.
     Problem of Prostate continued just after three weeks of aforesaid TURP.
     Till this time, the Sugar Level and BP was under Control with occasional exceptions of Hypoglycemia as aforesaid.
     The Creatinine level also started varying on Border Side as 1.2 to 1.3 since the year 2010.
     In August, 2010, Treatment of Dr. Vibhav Malviya, Allahabad continued in reference of UTI, for which Anti-Biotic was prescribed but the same shown Side-Effects of Hypoglycemia.
     Complaint of severe indigestion, for which treatment of Gastroenterology also started side by side.
     Admitted in Hospital in critical position of Hypoglycemia in the Second week of September, 2010. Serum Sodium, Serum Potassium and Hemoglobin was found substantially low, Five days treatment in Hospital, then Discharged.
     Calibration was done by Urologist to remove obstruction, if any, for treatment of Prostate.
     In Last week of December, 2010, TURP was again done in XXXXXXX Hospital, New Delhi.
     Since then, no problem of Prostate.
     Swelling (edema) is continuing since last one (1) year in the feet and ankles and since last six-seven months in the face and around the eyes (facial swelling).
     In third week of September, 2011, Vocal-Cord (Voice blurred) / Viral Infection occurred and he confined to bed with complaint of Extreme Letharginess / weekness, pain in legs, inability of living Bed, for which, five days medication was prescribed, which culminated the problem of Vocal-Cord (Voice blurred) / Viral Infection.
     However, Extreme Letharginess / weakness, pain in legs, unwillingness of leaving Bed continued.
     Blood & Urine Test prescribed, whereupon, the Creatinine level reached upto 1.8 along with High Level of Sugar as 250 to 300 in the Blood Tests done fortnightly and one Doctor's Diagnosis was about "Renal Infection", for which "Micropenem" Injection (1 gm. dose immediately and 500 mg. thrice a day) was administered. For two days Injection continued.
     One another doctor stopped the said injection and started Oral Medication. The Swelling (edema) in the feet and ankles and face vanished within four days and the Tab DYTOR 20 Mg was reduced to half. However, the complaint of Extreme Uneasiness for whole days especially during night with distorted slipping started just after two (2) day of said Oral Medication. As such, the said Doctor was consulted, whereupon, the Tab METOLAR-XR was stopped. The complaint of Extreme Uneasiness for whole days especially during night with distorted slipping started reducing continuously. (Please refer the letter-head of Dr. XXXXXXX Singh)
     My father (aged about 69 years) has always been a Sports person through out his life and Carrier in legal filed having Diabetic history of last 20 years and 8-9 years history of Hypertension, which has developed increase in creatinine (maximum upto 2.0, but on average 1.6) since last one and a half years, prior to which it was on border line of 1.3 or 1.2 and also increase in extreme letharginess.
     However, due to panic of Medication, All the Oral Medication was discontinued except Sugar and BP medicine, which are continuing as follows: -
     GLUCONORM PG-2      (1 Tab Morning & 1/2 Tab Evening),
     JANUVIA 100 Mg           (1 OD),
     MOXOVAS     0.3          (1 OD)
     In the month of October, 2011, The creatinine Level reached at 2.0 along with High Level of Sugar as 250 to 340 in the Blood Tests done fortnightly and Urine-Protein level Twenty time more than the normal level. The Doctor at the XXXXXXX Hospital, New Delhi was approached, who started administering Insulin with Medicines AS MENTIONED IN CURRENT MEDICINE COULMN.
Answered by Dr. Avinash Ignatius 13 hours later

Thanks for posting your query. I also appreciate the effort at providing a detailed history. It is rare that we get so much information.

From your history I gather your father has Diabetes/ Hypertension/ Early Parkinsonism/ Prostate problems (TURP)/ Chronic kidney disease ( A serum creatinine of 1.6 indicates that about 40-45% of the kidney is functioning.).

All over the world, it is recommended that the haemoglobin be maintained over 11g/dL. It is essential to administer erythropoetin to achieve this.

There are a few reasonably good alternatives to Espogen. If administering the drug is a problem, the dose can be doubled to 6000 U once a week. Also there are alternatives to erythropoetin like Arenasep (can be given once in 2 weeks) or MirCERA (Can be given once in a month). You can ask your nephrologist about these alternatives.

The medications prescribed are quite appropriate for his disease. However trying to keep sugars in near normal range is fraught with the risk of repeated hypoglycemia. It is preferable to target his sugars at slightly higher than normal (say fasting 120 - 150 and post meal 160 - 190) as repeated episodes of hypoglycemia are also not good in the long run.

I hope I have answered your query. I will be available for follow up queries.
Above answer was peer-reviewed by
Follow-up: For how long Inj.Espogen is to be continued? How to control kidney damage, BP and blood sugar? 9 hours later
Resp. Doctor,
I am extreamly thankful for your valuable reply.
However, being Lay-man for Medical field (I am in Legal Professio), I am willing to ensure my self about the "phrase" you have used as "(A serum creatinine of 1.6 indicates that about 40-45% of the kidney is functioning.)"
My querries are
1. As to what is the normal range of serum creatinine ?
2. Whether the "phrase" used by you is an indication of damage/decay of Kidney and if yes, whether the general saying, that serum creatinine up to 2 is not so alarming, is correct or not ?
3. What are the possibilities to maintain the "Status Quo" of the said serum creatinine of 1.6, in avarage, and how much long along with my father's current status of health as he returned to his normal daily routine of Morning Walk and Yoga having no complaint of tiredness?
Answered by Dr. Avinash Ignatius 15 hours later

Here are the answers for your query.

1. The normal serum creatinine value reported range from 0.7 to 1.1 - 1.4 depending on equipment used. However creatinine is a very rough indicator of kidney function.

2. True indicator of kidney function is GFR (Glomerular Filtration Rate). Normal is more than 90 ml/min. Serum creatinine starts rising only once the GFR drops by 50% i.e. below 45 -50ml/min. So unfortunately by the time someone sees creatinine rising, there is already a 50% loss.
Though Sr creatinine of less than 2 is not alarming but it cannot be ignored. This is the best time to optimize treatment and reduce progression.

3. Generally there is no specific time duration or formula to say how long his creatinine remains 1.6, as it really depends on multiple factors including a proper assessment of your father. This is more easily answered by your treating Nephrologist. He definitely should continue his routine activities as per tolerance.

Above answer was peer-reviewed by
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