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Dr. Andrew Rynne

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What do these following lab reports indicate?

Answered by
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4361 Questions

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Posted on Tue, 27 Oct 2015 in Kidney Conditions
Question:
Male of South Asian origin, 71 year old, slight built, normal body weight, though ,low BMI, diabetic for over 10 years, has been under medication, but blood glucose not well controlled.

Serum Creatinine currently at 1.53 mg/dl. Attached is the blood picture report and also ultrasound report of abdomen.

Question: Is there any requirement of additional tests for assessment of kidney damage? What is the extent of damage to the kidneys? is this reversible? What do we do now and what is the order of prioritization?

Please - I want response from a nephrologist.

Thanks
doctor
Answered by Dr. Rakesh Madhyastha 5 hours later
Brief Answer:
? Chronic kidney disease

Detailed Answer:
Hello

Thanks for the query

I have seen the attached reports and it looks like you have a small right kidney which requires further evaluation. The idea is to rule out a non diabetic kidney disease.
Now to answer your questions

1. Yes, you will require additional tests. A smaller right kidney usually means there is either renal artery stenosis or reflux nephropathy. I suggest you to get a renal artery doppler done followed by a DMSA scan to look for renal scars. Based on the results I would order a micturating cystourethrogram to rule out reflux

2. At current creatinine your renal function is about 60%. To know whether or not it is reversible you must get a urine routine and the above tests done.

3. In order of priority here is what you should do

*Treat anemia, get your iron profile tested.
*Avoid nephro toxic drugs especially pain killers
*Lose weight if you are over weight
* Check for diabetic retinopathy by meeting an opthalmologist
*salt restricted and potassium restricted diet ( avoid fruit and fruit juices)
*Get urine routine, renal artery doppler and DMSA scan done
* Make sure your sugar and blood pressure is under good control

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Rakesh Madhyastha 40 hours later
Thanks a lot for a very useful evaluation.

Here is a follow-up question.

While either renal artery stenosis or reflux nephropathy are possible reasons for the small right kidney, we want to know whether kidney stones could be a possible culprit. He (the subject) had a long history of kidney stones - first noticed about 30 years ago when it was very painful. He had been under homeopathic treatment, which at least resulted in the pain having gone away. About 7 years ago, imaging studies revealed stones (s), and homeopathic treatment was resumed which resulted in remission of symptoms. Does the current ultrasound show any evidence of stone (s) and whether there is a possibility of this being the cause of renal impairment?

Many thanks again
doctor
Answered by Dr. Rakesh Madhyastha 22 hours later
Brief Answer:
Could be a possibility

Detailed Answer:
Hello

Thanks for getting back, I am sorry for the short delay in my reply. I was on call at my hospital.

Unilateral small kidney is usually due to reflux nephropathy or renal artery stenosis, however recurrent stone disease can lead to small sized kidneys as well. To know you will have to get a dmsa scan to look for scars

Whatever maybe the cause the treatment is the same. You will need to be on ace/arb. I usually give telmesartan once a day, this is a renoprotective agent

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rakesh Madhyastha 26 hours later
Thanks again for clarifying the issue about kidney stones. In the first post, you had mentioned that the subject should avoid all nephrotoxic drugs. Here is the list of his current medication;

.) Dytor 5 mg
2.) Amaryl 2 mg
3.) Zyloric 100 mg
4.) Galvus. 50 mg
5.) Cinod. 10
6.). Dexorange caps

I believe Zyloric could be nephro-toxic. Could this be also the reason of impairment of kidney function? Also about your suggestion to use ARBs, following is an excerpt from drugs.com

"Although doctors often prescribe ARBs to help protect the kidneys, people with certain kidney conditions — like narrowing of the arteries feeding the kidneys (renal artery stenosis) or very poor kidney function — shouldn’t take ARBs"

I would request you to kindly suggest alternative medications - in case you think the medications in the current list should be changed or stopped?

Many thanks again

doctor
Answered by Dr. Rakesh Madhyastha 13 hours later
Brief Answer:
Switch over to febuxostat

Detailed Answer:
Hello

Thanks again for getting back and it's wonderful that you are educating yourself about your condition, such patients always do better than others.

Here are the answers to your doubts

1. I prefer febuxostat over zyloric, it's safer In renal failure. It's started as 40mg once a day
2. ace/ arbs are contraindicated in bilateral renal artery stenosis and acute kidney injury. Once the creatinine has stabilized it's best to be on ace/arb
3. all other drugs can be taken

I am sure you will have several other doubts, I'll be happy to clarify them all. Please feel free to get back
Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Rakesh Madhyastha 3 days later
Thanks for your prompt response and very useful advice.

After a month of the initial test (of August 31), we had got the serum creatinine retested again (from a different lab). The current value appears somewhat lesser @ 1.50 from a previous value of 1.53. Is this reduction anything meaningful or within the range of tolerance of the first value?

Does it meet the criteria of a stable creatinine level? Or should we wait for the other tests to be done before changing the BP medications suggested by you?

Thanks again


doctor
Answered by Dr. Rakesh Madhyastha 20 hours later
Brief Answer:
Not much change

Detailed Answer:
Hello

Thanks for getting back. A change of 0.3 does not indicate any improvement in renal function however it is still good news as the there is no further deterioration of renal function.
Yes it meets the criteria for stable creatinine, blood pressure medications can be changed over or ACE/ARB can be added.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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