Promises of improved kidney function?

Hi Petuniamom, I’m wondering if you called your doctor and how you’re doing?

Doc gave me Altace 2.5.Made me extremely shakey, borderline dizzy, tired, slightly sick feeling. Took away chest pain which which was supposedly esophageal instantly. Took 3 pills. Spook with nurse. Stopped taking today. Felt better but have to be on some pill in that category. Waiting to hear back.

HI Ginger, you seem to be well informed about all this kidney stuff so I was wondering if you could help me out? I had been holding steady at a GFR of around 60, (which I am kind of embarrassed to be complaining about), so I was never told that my kidney function was nearing Stage 3 CKD. Until it hit 59 and then all of a sudden "you have kidney disease". What? 60 is normal but 59 puts me at Stage 3? Anyway, I had a UTI at the time, when they mentioned my declining kidney function and was put on Bactrim. A recheck showed that while on Bactrim (and during the UTI) my GFR dropped 5 more points to 54. I was so panicked. Well, they added a new BP med (amlodipine) and my next two GFR's were miraculously improved at 64 and 73 (on 10/11). At the point, with a GFR of 73, my nephrologist felt it was okay to restart a tricyclic anti-depressant that had been very helpful in the past, but has some caution with kidney disease. I was supposed to start it today. I got a metabolic panel yesterday and my GFR was back down to 60. Now I don't know what to do about restarting the antidepressant and also wondering why I seemed to be improving and now declining again? I feel depressed because I fear further decline should I restart the meds. Any thoughts would be much appreciated. Thank you.

@csage1010 Frustrating, isn't it!? It makes it appear like there is a "magic threshold" to recognize kidney issues at.

Perhaps you have seen my comments before, that I consider our bodies to be such miracles, and so many individual systems work together. When we are not feeling good, sometimes those systems show different values as they deal with whatever it is we are fighting. For the most part, our doctors are going to be looking at trends in blood values, not necessarily a one-time spike or dip. Or they should be.

An increase in GFR to 73 may be temporary, seeing it has been hovering around 60. A different set of lab machines running your samples, your hydration levels, your stress levels, all could contribute to a reading that isn't consistent to what you have been used to seeing. As for starting back on a medication you were off of, that is definitely something to speak to your dr about. You can question why he/she deems it is okay to restart. And then, make your decision. Is there something else that can be used, that has fewer negative interactions with the kidneys?

Let me know if this helps you, and how I may be of further service.
Ginger

A key element in your discussion is the new use of Amoldipine. That is used to manage high blood pressure and its use may have contributed to improvement in your GFR. Otber factors might be varying blood glucose levels .

@miker8888 Funny you should mention amplodipine! I was switched to that in June, at 10mg once a day. When it took my BP lower than the dr liked, it was changed to 5mg once a day. Two weeks ago I went onto darmepoetin alpha shots, which will increase my red blood cells. A side effect can be a BP increase, which it did. So not I am back to 10mg once a day! My eGFR has remained fairly consistent at 16%. Prior to amlodipine, I was on benazepril for decades.
Ginger

It is particularly difficult to stabilize BP when the kidneys are failing but so very important to stabilization. I am currently in stage 4 and my BP suddenly elevated to 170 to 180. After unsuccessfully trying to lower it, my cardiologist put me on hydralazine, a vasodilator. My nepthrologist agreed that lowering the BP was more significant than possible effects of the drug on my kidneys. So far, my GFR has been stable.

Keep at it, I will be rooting for you.
..

It is particularly difficult to stabilize BP when the kidneys are failing but so very important to stabilization. I am currently in stage 4 and my BP suddenly elevated to 170 to 180 and my GFR decreased markedly. After unsuccessfully trying to lower it, my cardiologist put me on hydralazine, a vasodilator. My nepthrologist agreed that lowering the BP was more significant than possible effects of the drug on my kidneys. So far, my GFR has been stable.

Keep at it, I will be rooting for you.
..

Decided to comment on my experience with amlodipine. I am stage 4 CKD and also diabetic (pancreas transplant in 2005). My last GFR was 30 (it has bounced between 14 - 42 over the past 5 years). My nephrologist has me on BP meds. They are torsemide (diuretic) in the morning and losartan at night. At some point he added over the counter sodium bicarbonate (antacid) because he thought my urine was too acidic. That caused an increase in BP. I hate it when meds have to increase because one med to treat one thing has side effects that cause something else which requires an additional med to treat that …… and so on. He put me on amlodipine for a month trial of it. It was effective and he decided to have it be a routine daily med. I decided I didn’t like the effect of the sodium bicarbonate when I found out that the active ingredient is the same as Tums so I stopped taking it. Then my BP started to be alarmingly low. I contacted my nephrologist and was told to resume the sodium bicarbonate but at half the amount and to switch amlodipine from daily to PRN (as needed). I take amlodipine only if the BP is greater or equal to 140/90. Been doing this for awhile now. I am due for labs and nephrology follow up so we shall see.

Hi Ginger, after seeing my primary care yesterday (and crying through the entire visit), we decided that it was best to try a newer generation antidepressant that may have less implications for CKD. My amlodipine was increased and my lisinopril was decreased. He agreed to monitor my GFR more closely.