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Somebody tell me why CKD stage 3a or 3b is no big deal.
The knee-jerk prescription of every healthcare provider I see is for me to "take some Ibuprofen" even though I've been doing that consistently since 1990.
Then, surprise, I get told to not take any NSAIDs at all by my PCP. I look up his reasons, and it tells me I have stage 3b chronic kidney disease. To the best of my knowledge, the stage after 3b is stage 4, and that appears to be a big deal as far as the subject of kidney disease goes.
Not according to the Nephrologist I asked to see. She thinks it's all no big deal. She thinks I need to stop having trouble forgiving 30 years of PCP's knee-jerk just telling me to take Tylenol and/or Ibuprofen for what I now know is a whole raft of things wrong with my C and L spine, and "move forward" in my life. "Move forward into what?" Was my reply. She never answered that one. She even reminded me I am 70 years old, and just how long do I plan to live from now on? I told her I have religious issues with options such as donor kidney's and blood transfusions. It's like that wasn't a real problem that I need to consider among my options for this future I am supposed to just forgive past healthcare providers who knew my kidney's were gonna get shot, but hey, it avoids me taking opioids.
I'm seriously wondering if I've got a bad kidney specialist or what? Your thoughts on this situation would be most appreciated? Thank you.
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No I am incontinent anyway I where atn diapers.
My gfr is 37 and doctor has suggested I take
Dapagliflozin
I am
Also on statin for high cholesterol and for the past month have been having muscle pain
Has anyone tried this drug for Chronic kidney failure ? It seems to have troubling side effects
@looplu79 I had a 36 and it went up to 41 with hydration, sometimes even higher. Did you hydrate well before your blood test?
Do you have type 2 diabetes?
I have been told that muscle loss affects the creatinine based eGFR so my doc also does a Cystain C GFR.
I looked up the drug:
Dapagliflozin is a medication used to control high blood sugar in people with type 2 diabetes123. It is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that helps the kidneys remove sugar from the blood through urine, thereby decreasing blood sugar levels23. It can also lower the risk of heart attack, stroke, kidney disease, and hospitalization for heart failure in people with type 2 diabetes3.
@looplu79
Dapagliflozin is Farxiga, which is advertised daily on the TV. When you say your doctor, are you talking of your endocrinologist, nephrologist, or PCP? There are different Farxiga doses for type 2 diabetes and CKD. Just because they advertise daily doesn't mean that it is an acceptable drug in both cases. If you go to their site and other medical websites, you will find that the adverse side effects can be harmful to some, and place you into later stages of CKD, which happened to me. However, some patients can benefit as well. In my opinion, the right approach is not the drug, but get further testing.
There are 2 eGFR common tests for kidney function, creatinine and Cystatin C. The latter in many cases is not covered by medical insurance, and can run a few hundred dollars or so. Neither of these 2 tests are definitive. The most accurate kidney function test is a 2.5 hour nuclear contrast study that will accurately define the function of each kidney and is called Iothalamate. If there is a discrepancy between the 2 common tests or depending upon the reliability of one over the other, this test is best served for those with Stage 3 or higher CKD including dialysis. Avoid getting possible severe side effects and higher CKD stages with Farxiga by going to your nephrologist and getting a more definitive nuclear kidney function study.
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Hug
1 ReactionI am
Not in U.S.
in UK we see a family doctor Initially
I have regular tests as I have Ankylosing spondilysis and am
Monitored by specialist hospital
Thank you for your very useful information
I am speaking to doctor tomorrow
None of my doctors reacted much to my eGFR of 36. Even though it was a sudden drop. I was glad to get a much higher eGFR from Cystatin C (51). I was told the truth lies in between. I am not sure whether a nuclear contrast study would harm kidneys. I avoid all contrasts that affect kidneys: @college prof may know something I don't.
Hydration and avoiding NSAID's also help. My creatinine based GFR is still 40. Because I am on (low dose) Reclast for bones I did get some extra tests but otherwise I think my nephrologist would have seen me in a year. Apparently the key is whether it is stable.
I do not have high blood pressure which would need to be addressed as well, with meds and/or diet.
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Hug
1 Reaction@windyshores I urge you to talk with your nephrolgist about the nuclear study. Why would Mayo and other major hospitals use contrast that would harm the kidneys for a kidney function test? A CT scan uses a different dye not suitable for CKD patients. @looplu79
You are correct that the answer lies between the 2 common tests as a formula is reached by the National
Kidney Founation that nephrologists use. Much of the measurement that a nephrologist also observes is the trend of the sodium, phosphorous, and potassium levels when comparing the 2 eGFR tests. For example, if you have a eGFR creatinine score of 45 and a Cystatin C score of 23, a nephrologist would give "slightly" more relevance to the Creatinine score if sodium, potassium, and phosphorus levels had a normal trend. That is why the nuclear test is so helpful.
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Hug
1 ReactionMY eGFR is stable at around 40. If it drops again I will certainly make an appointment. I did a CT with oral uranium and got really sick, but not necessarily due to kidneys (it wasn't investigate).
Cursory googling would seem to say that a nuclear kidney scan is fine but it may be more complicated than that https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380202/ I need to look into it further.
I have been told the creatinine based eGFR is affected by all kinds of things: hydration (of course), exercise, low blood pressure, low ejection fraction (heart), muscle loss etc. and that the Cystatin C is more stable. But yeah, my true GFR is probably around 45.
I have a 20% dose of Reclast with one hour IV hydration and infusion over one hour. Normal dose is 5mg over 12 minutes I believe. I wish I could still take my NSAID!
@windyshores What nephrologists and their associates look for is consistency. In an ideal world, the 2 tests should come close, but that is not always the case. If you are a Mayo patient, they have a pamphlet on the procedure and Iothalamate dye. The nuclear kidney test is not complicated but it involves drinking water, inserting the dye, and emptying your bladder. If you want accuracy of kidney function, this is the best and safe test for most. It also allows the nephrologist to prepare a patient for dialysis or transplant.
Again, you are correct. There are a lot of variables that go into the Creatinine eGFR test, and for that matter, changes may be inconsistent for quarterly testing. Cystatin C is more stable as you suggest, but stability does not equate to accuracy as this nuclear test does.
Last thing about Nsaids, over time you can expect gastric issues including Crohn's disease. Glad you are off that.
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Hug
1 ReactionI never took NSAID's often. I have always been aware of GI effects. But I have trigeminal neuralgia and took Flurbiprofen when I could not stand it. I also took it after spinal fractures. I have never taken it more than once in, say, two weeks and usually once in a month.
I would do a nuclear test only if my life depended on it in an immediate sense.
https://www.drugs.com/cons/iothalamate-meglumine.html
It does mention caution with kidney disease and a few other ailments I have.