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Urology (Expert Forum)
A collision course with dialysis. Diagnosis: membrainous nephropothy
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
A collision course with dialysis. Diagnosis: membrainous nephropothy
by Normajean, Nov 27, 2004 12:00AM
Is my next step a diagnosis and treatment center? Age 67. I have an inherited autoimmune system with serious diseases (RA, Chones, diabetes). My nephrologist says I have approximately 40% kidney function. My protein spill is over 9 grams daily. Cyclosporine did not bring it down. I am back on lisinopril 5mg daily and monitoring blood pressure closely. Also taking polycitra-K as I have crystals in urine. I am a candidate for bloodclots so drink plenty of water.
These are other reasons for the question. My thyroid is very unstable, changing with each blood test. I have mild microscopic colitis with uncontrolled diarrhea (almost constant, but occasioncl normal bowel).I am anemic with no blood in urine nor feces. My heartbeat is irregular afternoons and evenings. I take Protonix 40mg daily for GERD, levsinex .375 twice daily and levsin sl .125mg as needed for Irritable Bowel Syndrome. Lasix 40mg twice daily for edema (even though I add no salt nor salt substitute). Lipitor 10mg daily. I do not tolerate NSAIDS at all (kidneys react). I need to include osteoarthritis, fibromyalgia and costocondritis for which I take no medications.
I am 5'8" and weigh 148 lbs. I have stayed in good physical condition and actually feel good. I've managed the pain with exercise and emotional stability.
I would like to save what kidney function I have and get everything under control. What's next?
These are other reasons for the question. My thyroid is very unstable, changing with each blood test. I have mild microscopic colitis with uncontrolled diarrhea (almost constant, but occasioncl normal bowel).I am anemic with no blood in urine nor feces. My heartbeat is irregular afternoons and evenings. I take Protonix 40mg daily for GERD, levsinex .375 twice daily and levsin sl .125mg as needed for Irritable Bowel Syndrome. Lasix 40mg twice daily for edema (even though I add no salt nor salt substitute). Lipitor 10mg daily. I do not tolerate NSAIDS at all (kidneys react). I need to include osteoarthritis, fibromyalgia and costocondritis for which I take no medications.
I am 5'8" and weigh 148 lbs. I have stayed in good physical condition and actually feel good. I've managed the pain with exercise and emotional stability.
I would like to save what kidney function I have and get everything under control. What's next?
Doctor's Answer
by Kevin Pho, MD, Nov 29, 2004 12:00AM
, Nov 29, 2004 12:00AM
Here are the indications for dialysis from UptoDate:
* Pericarditis
* Fluid overload or pulmonary edema refractory to diuretics
* Accelerated hypertension poorly responsive to antihypertensive medications
* Progressive uremic encephalopathy or neuropathy, with signs such as confusion, asterixis, myoclonus, wrist or foot drop, or, in severe, cases, seizures
* A clinically significant bleed attributable to uremia
* Persistent nausea and vomiting
* Plasma creatinine concentration above 12 mg/dL (1060 µmol/L) or blood urea nitrogen (BUN) greater than 100 mg/dL (36 mmol/L)
I'm not familiar with your case, so I cannot comment on whether you need dialysis or not. However, if you meet one of these criteria (i.e. discuss them with your physician), then dialysis should be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Hakim et al. Indications for initiation of dialysis in chronic renal failure. UptoDate, 2004.
* Pericarditis
* Fluid overload or pulmonary edema refractory to diuretics
* Accelerated hypertension poorly responsive to antihypertensive medications
* Progressive uremic encephalopathy or neuropathy, with signs such as confusion, asterixis, myoclonus, wrist or foot drop, or, in severe, cases, seizures
* A clinically significant bleed attributable to uremia
* Persistent nausea and vomiting
* Plasma creatinine concentration above 12 mg/dL (1060 µmol/L) or blood urea nitrogen (BUN) greater than 100 mg/dL (36 mmol/L)
I'm not familiar with your case, so I cannot comment on whether you need dialysis or not. However, if you meet one of these criteria (i.e. discuss them with your physician), then dialysis should be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Hakim et al. Indications for initiation of dialysis in chronic renal failure. UptoDate, 2004.
