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What Causes Fluctuating Blood Pressure And Hyperkalemia While Suffering From Renal Artery Stenosis?

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Posted on Thu, 11 May 2017
Question: 46 yr old male, CKD stage 3, 1/2 of left kidney removed at age 4yrs,born dead. He just had a renal artery scan and they had a hard time finding the arteries. However his cardiologist who ordered this scan would not let us see it. What I've read, as a retired medic, tells me that of there is any renal artery blockage it would cause such symptoms as uncontrollable bp, fluctuating pulse, fluctuating 02 sats, light headedness, general weakness, etc. He was diagnosed in September with celiac disease so we changed his diet accordingly. 2 weeks later his appendix needed to be removed, post-op he goes into acute renal failure and was hyperkalemic with K being 6.4. Took 4 days to get K back down to 4.5. Changed his diet again to now also watch potassium intake. Yet since that incident in September 2016, doctors have had a hard time stabilizing his bp, 02, or pulse. Bp goes from 128/78 asks hour later he'll get a headache and bp is now 174/120! The lower the bp, the lower his 02 levels are and the lower his pulse is. Cardiologist is telling us his issues aren't cardiac but rather renal! So that's why we are asking you. Another question is doing his week long hospital stay, the changed his heart meds. They went from 50mg metatropal twice daily, increased to 75mg twice daily. The nephrologist ordered his 20mg amalodipine stopped due to the pedal edema. Now his heart meds said any edema from amalodipine isn't significant enough to mess with his hyperkalemia. We're so confused about what to do. He was on long term disability from work until a clerical error named the wrong oxygen provider, so we are appealing that. The cardiologist is saying despite the severe chest pains, uncontrolled bp, tachycardia, heart palpatations (on EKG today is called the palpitations anterior infarcts), etc. All of these changes happen when he is sitting down relaxing! it's horrific of he gets up and walks from livingroom to bathroom. His job is a night restocker of frozen foods and other merchandise at Sam's club. He has to continuously lift 75+lbs, in a freezer set at -6'F! Is it safe for him to work under these conditions with his heart disease (3 heart attacks, 3 stent placements, total of 8 scopes of his cardiac vessels), his CKD stage 3, celiac disease, pulmonary pneumonitis caused by bird dust and feathers (being in a warehouse, there are a lot of small birds nesting on top of the stock and flying around kicks up All that dust and makes him cough a lot), hyperkalemia, borderline diabetic, and on 02 @2L all the time. Scheduled for sleep apnea test within the month. So after listing basically everything about his health, since the cardiologist thinks this is a renal issue, we were wondering what you thought? Could it be renal artery stenosis causing all of the above symptoms? Thank ypu for any help you can give us.
doctor
Answered by Dr. Ravi Bansal (34 hours later)
Brief Answer:
Adjustment of bp medicine by your doctor will help

Detailed Answer:
Hi,
If I gather correctly from your description.

the main issue is fluctuating blood pressure. and high potassium. other issues are pneumonia, celiac disease. and fear of kidney failure. and all this on a background of significant heart disease and occupational hazarrards.

so let's take it one by one.

high fluctuating bp is common in renal artery stenosis. and if that is the case then we have to see the creatinine level and whether the stenosis is in one kidney or both. after this we have to decide on the bp medicine. home bp monitoring is important. ace - inhibitors are very good to control bp in these patients if it is only one kidney stenosis and creatinine level is normal.
edema does not affect potassium level. it just shows water pretension. decrease water/ liquid intake and use diuretics like torsemide.

high potassium is generally due to high dietary intake. Stop any juices or fruits. decrease meat and non veg.

pneumonia if infective to be treated by antibiotics. celiac by diet modifications.

heart disease will need blood thinner, anti lipid and anti anginals.

exercise or work limit is decided by the patients ability to sustain exersion. if he can do some work without getting breathless he can very well do it.

he can protect himself with face mask if he is e posed to infected environment


in case there are further queries please write in.

best wishes
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. Raju A.T
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Answered by
Dr.
Dr. Ravi Bansal

Nephrologist

Practicing since :1996

Answered : 359 Questions

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What Causes Fluctuating Blood Pressure And Hyperkalemia While Suffering From Renal Artery Stenosis?

Brief Answer: Adjustment of bp medicine by your doctor will help Detailed Answer: Hi, If I gather correctly from your description. the main issue is fluctuating blood pressure. and high potassium. other issues are pneumonia, celiac disease. and fear of kidney failure. and all this on a background of significant heart disease and occupational hazarrards. so let's take it one by one. high fluctuating bp is common in renal artery stenosis. and if that is the case then we have to see the creatinine level and whether the stenosis is in one kidney or both. after this we have to decide on the bp medicine. home bp monitoring is important. ace - inhibitors are very good to control bp in these patients if it is only one kidney stenosis and creatinine level is normal. edema does not affect potassium level. it just shows water pretension. decrease water/ liquid intake and use diuretics like torsemide. high potassium is generally due to high dietary intake. Stop any juices or fruits. decrease meat and non veg. pneumonia if infective to be treated by antibiotics. celiac by diet modifications. heart disease will need blood thinner, anti lipid and anti anginals. exercise or work limit is decided by the patients ability to sustain exersion. if he can do some work without getting breathless he can very well do it. he can protect himself with face mask if he is e posed to infected environment in case there are further queries please write in. best wishes