September 14, 2009, 3:20 pm
Expert Answers on Kidney DiseaseBy The New York Times
Update | 2:08 p.m. Thank you for your questions. Dr. Spry will no longer be responding to new questions.
Dr. Leslie Spry, M.D.
This week Dr. Leslie Spry of the National Kidney Foundation joins the Consults blogs to answer readers’ questions about kidney disease. Dr. Spry is the medical director of the Dialysis Center of Lincoln in Nebraska, where he participates in research and innovative projects for the benefit of dialysis patients. His areas of expertise include nephrology, hypertension, dialysis, acute renal failure, kidney stones and chronic kidney disease.
Dr. Spry’s responses are posted in the Comments box below.
1.
1. September 14, 2009 5:50 pm Link
I have been diagnosed, along with other members of my immediate family, with PKD. Should my children (in their 30s) also be tested? I wasn’t diagnosed until my mid 50s. I worry about insurance and pre-existing conditions.
Dr. Spry responds: The problem here is as you state. There are reasons why, in the current insurance climate, you may not want to know if your children have polycystic kidney disease. This can lead to higher insurance costs in the present environment.
I recommend that patients with PKD in the family have their blood pressure checked and maintain good general health. They should have laboratory tests checked, including the eGFR tests, and then, if there is a complication or problem, the ultrasound test can be done. Many times the cysts are not visible and the diagnosis may be missed on children and teenagers. There is no compelling reason to make the diagnosis or perform a kidney ultrasound until complications of kidney disease arise.
— Pam Blome
2.
2. September 14, 2009 11:18 pm Link
What advice can you give a young adult with a family history (and 50/50 chance) of having polycystic kidney disease? What, if any, step can be taken to prolong kidney function?
Dr. Spry responds: Careful control of blood pressure, avoidance of and treatment of bladder infections, and good general health habits are the best way to prevent complications of polycystic kidney disease, or PKD.
I recommend that patients with PKD in the family have their blood pressure checked and maintain good general health. Exercise on a regular basis and follow a low salt diet. They should have laboratory tests checked, including the eGFR tests, and then, if there is a complication or problem, the ultrasound test can be done. Many times the cysts are not visible, and the diagnosis may be missed on children and teenagers. There is no compelling reason to make the diagnosis or perform a kidney ultrasound until complications of kidney disease arise.
— worried
3.
3. September 14, 2009 11:53 pm Link
My 75 year old father’s kidneys are functioning at 25%. He also suffers from mid-stage dementia and Alzheimer’s disease. His nephrologist advised that we talk to him now about whether or not he wants dialysis in the future, and that he make his wishes known in his living will. He is capable of making these decisions at this point and wants to know:
1) How will dialysis impact his quality of life as his Alzheimer’s progresses, and 2) How long can someone live with failing kidneys if they are not on dialysis?
Thank you,
Rose
Dr. Spry responds: Dialysis is a difficult existence for the elderly and infirm. Dialysis will make major demands on time and effort by the elderly. Patients must travel to and from dialysis, sit on a dialysis machine for three to four hours three times weekly and go through the usual ups and downs of a chronic disease.
As his Alzheimer’s progresses, he will understand less of what is happening to him and sometimes may rebel against his caretakers. This needs to be explored with him. Sometimes a visit to a dialysis unit can be very helpful in educating the patient about the demands of treatment. Many dialysis units offer pre-dialysis seminars that can be very informative for pre-dialysis patients. The National Kidney Foundation also sponsors educational events called People Like Us, Live. Please visit the NKF Web site at
http://www.kidney.org Dialysis is usually discussed and potentially started when the kidney functioning is between 10 percent and 15 percent. Natural deterioration of kidney function occurs at about 1 percent per year, so he may have several years left before dialysis is a consideration. The exact timing of starting dialysis, however, depends on many factors including diabetes, heart disease and general health. These should be explored with your nephrologist.
— Rose
4.
4. September 15, 2009 1:49 am Link
Recent research shows that the life expectancy and health of kidney donors is similar to non-donors. Should I take comfort from this research even though one of my kidneys was removed not for donation but due to the presence of a growth that was found to be benign?
Dr. Spry responds: Yes. If you are in generally good health and take good care of yourself, a single kidney can last you the rest of your life. This means taking care of it and controlling blood pressure, controlling diabetes, eating a healthy low salt diet and exercising regularly.
— David
5.
5. September 15, 2009 6:58 am Link
What is the effect of enlarged prostate over Kidneys function
Dr. Spry responds: If the bladder fails to empty completely (this is known as urinary retention), then pressure may build up on the kidneys and cause damage with loss of function. An enlarged prostate restricts emptying of the bladder and can lead to blockage and infection, both of which can damage the kidney.
— A.Padmanabhan
6.
6. September 15, 2009 8:50 am Link
I am concerned for a friend who is being treated for high blood pressure, has had 4 ablation surgeries for “a-fib.”, and who suffers from chronic muscle/tendon/joint pain and stiffness. He has used Advil 1200mg daily for several years with some relief and no guidance from his phsyicians regarding eliminating the discomfort or its source. I am very concerned re: the use of Advil with his other meds, tenormin, coumadin, lisinopril. The Drs. don’t seem to worry about this or have alternatives. What do you suggest? Should he have the KEEP screening test?
Dr. Spry responds: It is difficult to comment on complex cases such as this. The combination of Coumadin and Advil causes me great concern. Advil can cause decreased kidney function in certain instances. I would definitely have this patient discuss use of all medications, including over the counter and herbal medication with his doctor.
— masongreene
7.
7. September 15, 2009 8:55 am Link
Respected Dr.,
I have 15mm kidney stone in left side and about 10 mm in right side.
I am taking 15 ml Potrate MB6 three times a day and using more water fluid.
My question is whether it compulsory to go for lessor surgory or wait for result?
CA Sooratsingh Udawat
Dr. Spry responds: I am not familiar with Potrate MB6. Since it is a liquid used in stone disease, it could be one of several medications, including potassium citrate, sodium & potassium phosphate, or potassium chloride. I would guess these are medications being used for the medical rather than the surgical management of stone disease.
In general, stones that are less than 5 millimeters will pass without surgery. Stones larger than this are less likely to pass without surgery. In general, we try medical management first, but if this fails and pain continues or blockage continues, surgery is advisable.
— sooratsingh udawat
8.
8. September 15, 2009 10:22 am Link
Is nocturnal dialysis more effective strictly because of the increased amount of treatment time or is treatment more effective because the body is in a different, more compliant state for dialysis when we’re asleep? If a body is laying flat, does that help increase the effectiveness?
Dr. Spry responds: Studies are currently under way to determine if, indeed, nocturnal dialysis is more effective than conventional hemodialysis. There have been several small studies and single center studies that suggest that nocturnal dialysis may well be more effective than conventional dialysis. One large study looking at this issue is sponsored by the National Institutes of Health and is known as the FHN trial. The results of this trial will be available sometime in 2011.
As to why nocturnal hemodialysis might be better than conventional hemodialysis, the most often cited reason is that both more frequent and longer dialysis sessions result in lower blood pressure, less stress on the heart and cleaner blood. All of these findings have been reported in smaller studies.
— Eric
9.
9. September 15, 2009 11:03 am Link
I have had one kidney since February of 2005. The kidney was removed because I had a kidney tumor, which turned out to be benign. Every six months, I have my creatanine level checked. Last month, it was 1.3. Six months before, it was 1.1. My question is that within the last month, I have been getting up to go to the bathhroom twice a night, as opposed to either once a night or not at all. Could there be something else wrong with my remaining kidney that I shoiuld have checked by the KEEP program? (I’m 58, exercise in the gym about 5 times a week, and am not overweight. I have been taking Prozac since 1992, and I take restasis for dry eye.)
Dr. Spry responds: In order to detect kidney damage, two tests are generally performed. Your creatinine is normal and may be used to estimate your kidney function by what’s called the MDRD estimating equation. This equation can be found at the National Kidney Foundation Web site at
http://www.kidney.org You enter your creatinine number as well as the other information and it will give you an estimation of your kidney function. Normal for a single kidney should be in the range of 60 to 80 cc per minute.
The second test is a urine protein test. In patients with a single kidney, it is advisable to have a urine test for “microalbumin” as a very sensitive test looking for kidney damage to your remaining kidney. I do not think the change in your nighttime urine output is a serious sign, but I do recommend checking your urine for protein.
— Iris
10.
10. September 15, 2009 11:03 am Link
Is it possible for one’s primary care physician to give the test that measures EGFR or can this only be done by a specialist?
Thank you.
Eileen
Dr. Spry responds: Your primary care physician can have the eGFR test performed. The clinical laboratory should calculate this test for your doctor. However, if the lab does not do this test, you can go to the National Kidney Foundation Web site and enter the creatinine test result as well as the other requested information, and the eGFR estimating equation will give you a result.
— Eileen McGinty
11.
11. September 15, 2009 12:17 pm Link
I am 8l years old. My primary doctor has advised me that I am prone to kidney ailments. Would it be advisable for me to request a KEEP evaluation. Wallace D., Minneapolis, MN
Dr. Spry responds: The National Kidney Foundation recommends that all individuals over the age of 65 have an eGFR test performed by their primary care physician.
— Wallace D.
12.
12. September 15, 2009 12:58 pm Link
Dear Dr. Spry: My condition and EGFR number is very similar to Mrs. Johnson’s. I am in my mid-50’s. My question is how much can be done through diet and exercise and other lifestyle changes to arrest the decline of the kidney function. Can any function be gained back or is continued decline inevitable? Sandra, Yardley, PA.
Dr. Spry responds: The most important thing that you can do to prevent more rapid deterioration of kidney function is to carefully control blood pressure and keep it less than 130/80. Diabetes should be controlled to keep the average diabetes test (hemoglobin A1C test) between 6.0 and 7.0. Regular exercise and a diet low in salt are the most important ways to prevent kidney damage.
There is a natural loss of kidney function that occurs with aging, such that one loses between 0.5 and 1 percent of kidney function each year, so it is not possible to stop the natural age-related loss of kidney function. If, however, your blood pressure is poorly controlled and aggressive steps are taken to control your blood pressure with the proper medication, then kidney function can improve in the short term and some function can be regained.
— Sandra
13.
13. September 15, 2009 1:04 pm Link
My dad has PKD. My grandmother (father’s side) had it as well, but it didn’t require dialysis or transplant and she lived into her 80’s.
1) I’ve heard there is a test to determine if I have inherited PKD… can you tell me about it?
2) Is there anything I can do to keep my kidneys healthy — diet/exercise-wise?
3) Can you offer advice for gout sufferers who also have PKD? Are there ways to control the symptoms of gout with diet/exercise?
4) If my dad needs a kidney transplant, could I be a donor even though it’s possible I could have inherited PKD myself?
Thank you … we have had a lot of trouble getting adequate information from my father’s doctors on his condition and it’s been very difficult to know what to do. Thanks!
Dr. Spry responds: There is, indeed, a very expensive genetic test that can be done to tell the difference between the types of polycystic kidney disease, or PKD. From your description, my suspicion is that you have PKD Type 2, but the genetic test can tell the difference. We rarely use this test except for research purposes, or we occasionally use it in instances that you describe. When a relative of a patient with PKD wishes to donate a kidney, we may do the test to make sure the donor does not have the disease. Hence, the answer to your question is that if you have the disease, you may not be a donor.
The most important things that you can do to prevent more rapid deterioration of kidney function is to carefully control blood pressure and keep it less than 130/80. Regular exercise and a diet low in salt are the most important ways to prevent kidney damage. There is a natural loss of kidney function that occurs with aging, such that one loses between 0.5 and 1 percent of kidney function each year, so it is not possible to stop the natural age-related loss of kidney function. If, however, your blood pressure is poorly controlled and aggressive steps are taken to control your blood pressure with the proper medication, then kidney function can improve in the short term and some function can be regained.
Gout can be avoided by avoiding excessive intake of alcoholic beverages. High fructose corn syrup intake (as is found in many commercially prepared beverages and foodstuffs) also can increase the risk of gout. Keeping an ideal weight by exercising may also help gout. Gaining weight will increase the risk of gout. If this is unsuccessful, medication may be needed.
— Sarah A
14.
14. September 15, 2009 1:43 pm Link
I have been taking lithium for 26 years, am in my early to mid-40’s, female, Caucasian and my last creatinine reading was 1.09; previous readings were .9 and 1.0. My estimated GFR based on my calculation of the last creatinine level, is 58. What should I do next, if anything? The psychiatrist only checks the creatinine once a year. Lithium works better than anything else to control my true bipolar I condition, thank you kindly for your answers, becca
Dr. Spry responds: You are right on the border of chronic kidney disease. It is difficult to make specific recommendations without an examination. I do recommend careful follow-up testing with your physician and psychiatrist. Once per year testing sounds reasonable at present, but I agree with your concern.
— becca
15.
15. September 15, 2009 2:11 pm Link
My husband, now 65, has been on home dialysis for 3+ years now. When he first found out that he had kidnet failure, he submitted to a battery of tests towards getting a transplant. What his blood doctor told him iduring a bone marrow withdarwal is that he though he saw som eindication that his blood cells were odd or as the medical term has been described to me — myelodysplastic syndrome.
Since then none of the top three transplant hospitals will consider giving him a transplant as they explained, due to the high risk of him getting sick on the post operativ suppressive drugs.
However, his blood has stabilized since he has been on home hemodyalysis and I was wondering if he should get his bone marrow tested again to see if there is any hope of getting a transplant before he it too old.
Do you have any experience with this syndrome and what it your expert opinion — is a transplant out of the question?
Dr. Spry responds: I am not a hematologist, and in cases such as you describe, I consult with a hematologist (a docotr who specializes in blood and clotting diseases). I do agree that patients with myelodysplastic syndrome are at increased risk for complications of transplantation. Home hemodialysis, however, has recently been shown to have similar life expectancy to transplant survival. If he is on home hemodialysis, he may be on appropriate therapy.
— -denise
16.
16. September 15, 2009 2:54 pm Link
Hello,
I am a nephrologist and the creator of UKidney.com which is an internationally renowned resource in kidney disease. There are many services on the site for patients to get expert answers to their questions. In addition to Dr. Spry’s blog, please visit us at
http://www.ukidney.com Dr. Spry responds: Noted. Thanks for your help.
— Jordan Weinstein
17.
17. September 15, 2009 3:51 pm Link
I have heard there are –on occasion– mental illness implications related to kidney disease; especially post transplant.
Dr. Spry responds: Chronic illness of any type can make an individual very prone to mental health issues. Kidney disease is no exception. I tell my patients that they have to battle this disease every day of their life. As with any battle, some patients grow weary and may manifest different degrees of mental illness. Patients with chronic kidney disease and transplants take many medications, which may also contribute to mental health issues. Therapy and medication are sometimes needed to cope with mental illness.
— Chris C.
18.
18. September 15, 2009 4:46 pm Link
Dear Dr. Spry, at a recent visit to my geratrician, a visiting fellow — a physician from Kyrgistan told me after looking at my computer chart that my kidney function is quite poor. I am 81 yrs old and except for living with synthroid because of thyroid cancer 30 yrs ago, and long standing high blood pressure for which I take Corgard (a beta-blocker) and Moexipril (an ACE), I am active and strong and responsible for my and my 86 yr old husband’s health & wellbeing..
The next day the geriatrician called me to say that all the new blood tests were fine. And so were the tests for kidney function — for my age.
Since March of 2009 I have a rash on my legs and upper thighs with some spread to my arms. A biopsy showed a chemical sensitivity. A strong corticosteroid ointment to be used for two weeks only had no effect. Now I wonder if the rash has something to do with inadequate filtering by my kidneys.
I thank you in advance
Ruth Gutmann
Dr. Spry responds: I would trust your doctor, but you might ask your doctor for your exact eGFR test result. If I estimate your kidney function based on your age and the natural loss of kidney function that occurs with aging, I would estimate your eGFR at between 50 and 60 milliliters per minute. You might check with your doctor and see if this is correct. With your history of high blood pressure, your kidney function might be just a bit lower. Severe kidney disease would be a value of less than 20.
— ruth gutmann
19.
19. September 15, 2009 6:18 pm Link
I am a 54 year old female who just recently had two GFR scores, ten days apart, that were 56 and 58. I have high blood pressure that is under control with medication. My GFR has always been normal before. My doctor suggests I wait several months to be re-tested and then, if the GFR is still low, will refer me to a nephrologist. What do you think about this? I trust my doctor but don’t want to take any chances. Should I ask for a consult now?
Thank you.
Dr. Spry responds: Normal kidney function for your age is greater than 60 milliliters per minute. At 56 and 58, these are very close and I would concur with your doctor. I would also suggest a urine test for protein to be sure that the high blood pressure has not caused kidney damage. You might check to see if this was performed on your recent examination.
— Diane P.
20.
20. September 15, 2009 6:34 pm Link
Between 2003 and 2009 I have had creatine of 1.6 to 2.2; the most recent test results were 1.8 to 2.0 with BUN of 36 to 40. This summer I had a left renal artery stent. How bad are my kidneys and would you recommend an EGPR? Allan R.
Dr. Spry responds: I would recommend that you go to the National Kidney Foundation Web site at
http://www.kidney.org and click on the estimated GFR equation. You can enter all of the data yourself and get your own eGFR. I would also recommend that you have a urine test for protein. This will indicate whether there has been any damage done to the kidney and may help your doctor recommend appropriate treatment.
— Allan R.
21.
21. September 16, 2009 9:10 am Link
I have had high levels of creatinine for at least six years (along with idiopathic hypertension). Levels have been around 1.4, and more recently 1.6 (eGFR around 40). My primary care physician has pretty much ignored these levels, until I insisted on a referral to a nephrologist. I am a 49 year old woman with well-controlled high blood pressure. I am in extremely good physical condition, exercise very vigorously, have no weight issues, and have an excellent diet.
My mother had (and died from) kidney disease. No specific cause was ever determined, though the continuing theory was some autoimmune process. She was repeatedly tested for lupus, but results were inconclusive.
From my experience with my mother’s care, and now mine, it seems that the standard approach is to watch eGFR until I’m in ‘Stage 4′, then begin planning for dialysis or transplant. I see no attempt at intervention, and no desire to understand underlying disease process. Because my mother’s nephrologist believed that she had an autoimmune disorder, she was never placed on a list for a transplant. The last two years of her life, she underwent dialysis at home, was shuttled back and forth to hospitals and nursing homes, and died, miserable, at the age of 66.
So… is this what is in store for me? Is my kidney disease due to some genetic predisposition? Lupus? Some other autoimmune disease? Are there any interventions that could be taken to improve kidney function? I am deeply frustrated by the apparent low-key approach to treatment, and have no idea where to turn or what to do.
Dr. Spry responds: Kidney disease can truly be very frustrating, because it has no symptoms until very late in the disease and testing can document the disease, but there are very few diseases that have treatment that can be curative. Lupus is one of those diseases. While I’m not sure I can diagnose your particular disease, if you have protein and blood in your urine, then a kidney biopsy may be performed that will yield a specific diagnosis. Unfortunately, this diagnosis may not have a treatment. The nephrologist that you will be seeing or have seen should assess the risks of kidney biopsy with the potential to come up with a treatable diagnosis and discuss that with you. You and the nephrologist must make that decision together.
Lupus has very few specific symptoms and can mimic many other diseases. I would pursue this question with your nephrologist. There are reasons to suspect lupus if blood tests point to this diagnosis. If blood and urine tests do not point to the diagnosis of lupus, then the risk of doing a kidney biopsy (although very small) may be greater than the likelihood of finding a treatable diagnosis.
Otherwise, as you mention, the job of the nephrologist is to protect as much kidney function as possible and slow the process. Most forms of chronic kidney disease have a relentless progression that can be successfully slowed but not stopped.
— Cathy
22.
22. September 16, 2009 12:04 pm Link
I have been on detrol for a number of year. Could this lead to serious problems. I am 74 now.. I take a very low dosage 1mg once a day. ANd I have high blood pressure, and take Lipitor. Both my blood pressure and cholesterol are within the normal limits. SHould I worry ?
Dr. Spry responds: Detrol is used to prevent the leakage of urine from hyperactive bladders. It has no specific effect on the kidney. If you have bladder infections, detrol can make this worse. As long as you have good blood pressure control and follow your doctor’s advice, you should be fine.
— Judith Weller
23.
23. September 16, 2009 12:11 pm Link
My legs are swollen, I have been on BP pills for years.Now I have pain on my legs and bottock and atime I find it difficult to walk.Do I have kidney disease? Thanks.Nelly new york.
Dr. Spry responds: The symptoms that you describe sound more like problems of circulation. I would consult with your doctor and try to establish a specific diagnosis. The only way to tell if you have kidney disease is to have a blood and urine test. Your doctor may chose to perform this testing for you.
— Nelly
24.
24. September 16, 2009 12:12 pm Link
A recent blood test showed BUN fasting at 39 and;Creatomome at 1.8. The doctor’s statement on the report was “Decreased kidney fimction; stable.” He has not prescribed any treatment. My question is: is there anything I should be doing to get these figures within a normal range? James H., San Diego
Dr. Spry responds: I cannot establish a specific diagnosis based on the information that you have provided. The ways to keep your kidney function as stable as possible is to avoid all non-steroidal medications such as ibuprofen, naproxen and other agents that can reduce kidney function. You should follow a healthy low salt diet, exercise on a regular basis to maintain a normal body weight and drink plenty of water to maintain hydration. You should follow your doctor’s instructions and avoid over the counter medications that have not be reviewed by you doctor. There is a natural loss of kidney function with aging that progresses at a rate of about 0.5 to 1.0 % per year. This is a natural aging process and cannot be reversed. Careful control of blood pressure and diabetes will also prevent further kidney damage.
— James
25.
25. September 16, 2009 12:24 pm Link
Our 16 year old daughter was recently diagnosed with Collapsing FSGS. Can you address the ideal psychological preparation for a teenager with the diagnosis of a difficult chronic illness?
Dr. Spry responds: You are correct. This is a very difficult diagnosis and very difficult to treat. At the age of 16, this can be a very difficult blow with all of the body image issues frequently encountered in this age group. I would recommend a low salt diet, regular exercise and consultation with a pediatric nephrologist to guide therapy. There are some treatments, but the risks and benefits must be carefully weighed in this age group. The kidney biopsy can yield clues as to which cases should be aggressively treated and which should be treated conservatively. This disease can also be hereditary, and this should be discussed with the nephrologist. In a female, the most common treatment for this disease must not be used if pregnancy is possible or probable. This should be carefully discussed with her. Many times psychological consultation to deal with depression in chronic illness may be necessary.
— Anne C.
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1.
26. September 16, 2009 12:28 pm Link
People reading this article should take note - stay healthy and do not ignore the advice given. I lost my native kidneys to Strep Throat when I was a teenager. I am now 39 and headed back to dialysis for the third time. I’m in a pickle now - my antibodies are very high from previous transplants; searching for a donor has practically become a full-time effort. Donors are rare and changing attitudes about donation is a daunting task.
For a personal look into the life of a person with kidney disease, and a chance to make a difference in one person’s life, please feel free to meander through my blog.
I think the fact that I am out searching for my own kidney, instead of waiting for the healthcare system to do it, says a lot about where our national stands with Kidney disease. I’d recommend you just stayed healthy and avoided the entire process.
http://ineedakidney.wordpress.com Dr. Spry responds: The transplant system is in place to be fair and equitable to all persons awaiting a transplant. I sympathize with your plight. The average waiting time for transplantation in the United States today is between three and five years in most programs. All individuals reading this story should declare themselves organ donors and discuss this desire with their family members. Organ donors are the real heroes of life.
— Jason H.
2.
27. September 16, 2009 12:33 pm Link
last april i went for a physical. there was a small amount of blood in my urine. iwas sent to a urologist and i had an ultra sound and internal exam with a camera. everything seemed normal. i then went for a colonoscopy and upper tract exam again everything pretty much ok. after that i was sent for an exam of female organs with camera - seems ok. now i am passing a larger quantity of blood -went to dr monday urine test came back saying large amount of blood in urine, and the bleeding has increased in the last week. i am awaiting results from cbc and rest of urinalysis. they say i may have a uti. i am 66 years old and i do not know what to do next.
Dr. Spry responds: I cannot determine a diagnosis based on the information you have provided. You are seeing the proper physicians from your description. I believe this should result in a proper diagnosis. A nephrologist consult could be of help if your present physicians cannot establish a specific diagnosis.
— judy
3.
28. September 16, 2009 12:49 pm Link
Jane Brody’s article states that normal EGFR is 90 or above.
Readers should be aware that:
*EGFR declines with age.
*Average EGFR is over 100 for those in their 20’s.
Average EGFR is 75 for those aged 71.
*Chronic Kidney Disease is defined as EGFR less than 60, though many with a reading somewhat less than 60 live normal lives without any discernible .problems.
Dr. Spry responds: Your observations are correct. It may be best to say the eGFR should be greater than 60, rather than a specific number above this. The equation used to estimate the GFR is less accurate with GFR’s above 60. That is why the National Kidney Foundation uses less than 60 as our cut-off for a specific diagnosis of chronic kidney disease. With eGFR’s above 60, we require abnormal urine or other testing of the kidney to be abnormal in order to establish a diagnosis of chronic kidney disease.
— Norrie Hoyt
4.
29. September 16, 2009 12:54 pm Link
What causes recurring kidney stones, and what can be done to avoid them? I am 62 years old, my blood pressure is well below 130, and I drink lots of water.
Dr. Spry responds: The most common cause of kidney stones is an excessive amount of salt in the diet. High salt intake results in an excessive leakage of calcium from the kidney that can result in stone formation. Other causes of stones include gout, excessive intake of animal proteins, excessive intake of calcium supplements and infections. There are also types of stone disease that can be inherited in certain families. I recommend drinking sufficient amounts of water so that you are forced to get up once at night to pass urine, and then drinking one glass of water during the night while you are up to pass the urine.
— Julie G
5.
30. September 16, 2009 2:21 pm Link
About 5 years ago I lost 1/3 of my left kidney. This year I lost 1/3 of the right. Both times the doctors said the infarcs were probably caused by blood clots. I’m 52 and on Clonidine and Benicar for high BP as well as Coumadine and Pravastatin. While somewhat controlled, my BP has recently been as high as 209/130 and as low as 90/68. Typically the BP plummets after eating lunch so much so I find it hard to function and have to sleep. When it’s high I vomit. High BP runs in my family and no one involved has been able to control it within the suggested range in spite of exercise and good diet practices. What else should I be doing? I’m tired all the time. Is it the drugs?
Dr. Spry responds: This is a very unusual case. There are not many causes of blood clots going to the kidney that result in “infarcts” of the kidney. The most common cause would be small pieces of cholesterol breaking off and going into the kidney. Blood clots coming from the heart in patients with atrial fibrillation are another cause. Blood clotting diseases such as lupus anticoagulant or anti-phospholipid antibody disease and certain kinds of blood vessel diseases that are called vasculitis come to mind.
I cannot come up with a specific diagnosis based on the information that you have given, but you may need to be evaluated very carefully for rare diseases that cause blood clots to the kidneys. Once a specific diagnosis is made, treatment should be more successful at controlling your blood pressure. I would consider consulting a physician in a university setting if you are having problems getting a diagnosis with your present physician. A biopsy or arteriogram may be needed.
— Damon
6.
31. September 16, 2009 8:26 pm Link
Thanks to the NYT and to Dr. Spry for undertaking this important but difficult task. Dr. Spry’s answer to me is meaningful and useful and I shall now be able to ask the right questions.
Dr. Spry responds: Thank you for your kind words.
— ruth gutmann
7.
32. September 17, 2009 10:48 am Link
My grandfather is 89 years old and in failing health. He goes to dialysis 3 times a week, and has been on dialysis for 3 years. Although he is still mentally aware and a joy to be around, my family and I debate what should happen when (if) he develops dementia or becomes very ill. Could you explain what happens when a person is denied dialysis? How long does it take for the person to succumb? Is it painful? Thank you in advance.
See Dr. Spry’s response in the post, “Stopping Dialysis at the End of Life.”
— Maureen
8.
33. September 17, 2009 12:00 pm Link
How can a person keep working the one kidney that is functioning at only a small percent of capacity so that it can last and not end up on dialysis? How to know, or find information about diet, medicines, etc. that will help?
Dr. Spry responds:
Patients with a single kidney may live a long and healthy life. There is a natural loss of kidney function with aging that decreases at about 0.5 to 1.0 percent per year. Hence, if there is significant damage to this remaining kidney, it may not last the rest of your life.
In order to keep kidneys functioning as well as they can for as long as they can, I recommend: 1) Careful blood pressure control to 130/80, 2) Low salt diet, 3) regular exercise to maintain a healthy body weight, 4) avoid non-steroidal arthritis drugs such as ibuprofen and naproxen (and others), 5) avoid any unnecessary drugs that have not been prescribed by your physician, 6) treat any bladder or kidney infections promptly, 7) drink plenty of water, and
have your physician test your kidney function at least twice yearly to catch any treatable problems with your kidney.
— Shirley
9.
34. September 17, 2009 1:40 pm Link
I was diagnosed with PKD at the age of 30. My maternal grandfather had it and died at the age of 42. My mother had it, had a transplant, her body rejected after 7 years, and she went on dialysis. She passed away at the age of 68. My maternal uncle also had PKD and passed away. My younger sister (age 54) had a transplant last year and is doing fine. So, I feel I am doomed.
My left kidney is non-functional. My right kidney has function somewhere between 17-30%. My kidneys are so large they have now grown from my back into my abdomen, and I am miserable. I have a very hard time sitting, bending over, living a normal life. I saw a new urologist yesterday about removing my left kidney. He suggested (1) draining the cysts percutaneously; or (2) draining the cysts, then removing the left kidney.
What is your opinion on my situation. I am scared and very tired of living with a huge stomach and a left kidney that doesn’t function but hurts me every day. I would truly appreciate any advice you may offer. Thank you.
Dr. Spry responds:
I do not recommend puncture of cysts in polycystic kidney disease. This is not a recommended procedure in the treatment of polycystic kidney disease today. If you are having pain and discomfort, I would first seek the consultation of a nephrologist about getting on a transplant list. You are eligible for the transplant list when your eGFR is less than 20 cc/minute. This will allow you to spend some time on the list and hopefully avoid dialysis.
If the pain and discomfort continues to be intolerable, then potentially removal of both kidneys and then going onto dialysis while awaiting a transplant is your best option. I would discuss all of these issues with your nephrologist and come up with a plan that both you and your nephrologists can agree on. I would also avoid all tight fitting clothes and belts. You should avoid all caffeinated beverages, such as coffee and sodas, as these have been shown to potentially make cysts grow and be more painful.
— Brenda G.
http://consults.blogs.nytimes.com/2009/09/14/expert-advice-on-kidney-disease/?apage=2#comments
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