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What does raised cortical echogenicity in abdominal ultrasound report indicate?

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Posted on Fri, 15 May 2015
Question: I am (aged 63), has hypertension for the past two and half years and taking medicines regularly. I also have been diagnosed to have LBBB. Recently my blood creatinine value was found to be >2.5 and blood urea nitrogen 131. Ultrasound images of whole abdomen showed raised cortical echogenicity and reduced parenchymal thickness and loss of corticomedullary differentiation in both kidneys. Can this be cured? Pl advice
doctor
Answered by Dr. Rakesh Madhyastha (37 minutes later)
Brief Answer:
Needs further work up

Detailed Answer:
Hello

Thanks for the query

Loss of Corticomedullary differentiation and cortical echogenicity could be because of hypertension. Looking at your BUN and serum creat values it looks like there might be some reversible factors. This is how you should go about it

1. Stop Tab Losar for now as this can cause acute kidney injury
2. Get a urine routine and a 24 hour urine protein done
3. I want to know the size of your kidneys, please furnish that to me
4. Get a fundoscopy done, usually nephropathy patients first get retinopathy. If retinopathy is present then chronic irreversible kidney damage has set in
5. Follow a low salt and a low protein diet
6. Avoid potassium rich diet like fruits especially orange and banana

I hope I was of help, please get back to me for further queries.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Madhyastha (6 minutes later)
Sizes of kidneys are:
Right kidney: ~7.9 x 3.5 cm

Left kidney: ~8.7 x 3.8 cm

Urine test report indicated '++' for protein.

Can I take Apple regularly since my humoglobin is <12 when tested a fortnight back

Pl advice dos and donts pl. And thanks

Thanks a lot for your kind response. Kindly suggest for the query made in the above follow up question
doctor
Answered by Dr. Rakesh Madhyastha (6 hours later)
Brief Answer:
acute on chronic kidney disease

Detailed Answer:
Hello

Thanks for the query

Your kidneys are small in size and there is also proteinuria ( loss of protein in urine) which points towards chronicity. Please follow the instructions given by me carefully from now on. After a week I would like you to re start Losar as it is very good for protein loss and also for the protection of the kidneys. Check your creatinine again after a week and also potassium

You can eat an apple a day. More importantly you will need iron supplements. Please approach your doctor for it

I am sure you will have a lot of doubts, please feel free to clarify them

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha (1 hour later)
Dear Dr.
Thanks a lot for the kind advice. Shall interact after a week for progress.
Thanks again
XXXX


Brief Answer:
Dear Dr.
I am bit confused since in the first part you advised me to
"Stop Tab Losar for now as this can cause acute kidney injury" and subsequently
You mentioned, "......start losar after a week as it is very good for protein loss and also for protection of kidney....". Kindly clarify.
Thanks and regards
XXXX
doctor
Answered by Dr. Rakesh Madhyastha (11 hours later)
Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

You have asked a very good question. Here is why I decided this

1. Losar is a Angio tensin receptor blocker which helps in reducing protein loss and also is reno protective
2. Looking at your creatinine and BUN ratio it looks like you have an acute kidney injury
3. Losar is usually stopped when there is an acute kidney injury and re started at a later date

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha (3 hours later)
Dear Dr.
Thanks a lot.
Regards
XXXX

Dear Dr.
Further to my earlier information, results of blood test done just a couple of days back, for kidney function test is given below. This is the latest info.

UREA (Urease Glutamate Dehydrogenase) : 82.4 mg/dl (Ref: 15-50)

Serum Creatinine : 2.4 mg/dl. (Ref: 0.7-1.3)

Serum Uric acid : 8.99 mg/dl. (Ref: 3.6-7.7)

Blood Urea Nitrogen : 32.7 mg/dl (ref: 6-23)


Kindly update advice, if you wish to modify. Regret inconvenience

Thanks and regards
XXXX
doctor
Answered by Dr. Rakesh Madhyastha (20 hours later)
Brief Answer:
Recovering kidney function

Detailed Answer:
Hello

Thanks for getting back, it is never an inconvenience.

As you can see your BUN has come down and serum creat is also coming down. Please always repeat serum electrolytes everytime you do an renal function test. No other modification of medicine needs to be done.
Next time get a 24 hours urine protein and creat.

Regards
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4364 Questions

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What does raised cortical echogenicity in abdominal ultrasound report indicate?

Brief Answer: Needs further work up Detailed Answer: Hello Thanks for the query Loss of Corticomedullary differentiation and cortical echogenicity could be because of hypertension. Looking at your BUN and serum creat values it looks like there might be some reversible factors. This is how you should go about it 1. Stop Tab Losar for now as this can cause acute kidney injury 2. Get a urine routine and a 24 hour urine protein done 3. I want to know the size of your kidneys, please furnish that to me 4. Get a fundoscopy done, usually nephropathy patients first get retinopathy. If retinopathy is present then chronic irreversible kidney damage has set in 5. Follow a low salt and a low protein diet 6. Avoid potassium rich diet like fruits especially orange and banana I hope I was of help, please get back to me for further queries. Regards