Intrinsic Kidney Problem-What does Intrinsic Mean?

I don’t have any information about this, but hope you get some feedback. I understand your concern. Does he have type 1 diabetes?

He has type 2 Diabetes.

He was doing great controlling it. Back in March, he had some fluid retention and the doctor prescribed a diuretic.

He then started having struggles keeping his sugars down. Nothing changing in his diet.

He went back for tests in September and his EFGR had dropped. The only difference being the new drug, I researched the new med, contacted a Pharmacist and was told that the new diuretic could damage the kidneys and interfered with blood sugars (making them rise). He at that time, in September, stopped taking it.

I see. Does he see an endocrinologist or primary for diabetes care? I ask, because sometimes the endocrinologist may be able to offer more specialized care for the diabetes. I realize many T2 see their primary. Also, sometimes with T2, blood sugar levels sometimes increase for varying reasons (meds, injections, infection, etc.) or for no known reason.

He is seeing his primary for diabetes care, which I am coming to the conclusion that we need to change. Since the kidney issue suddenly came up. I'm not confident with his primary right now, especially since I had to ask for a referral to a Nephrologist.
I will start looking for an Endocrinologist as well...at least finding out who is in our area and reading up on their history/credentials. I like that you point our the "specialized care" aspect for diabetes. I hadn't thought about that before. Thank you for that.

Many type 2s see their primary and it works well, but sometimes the condition progresses and is more challenging to manage. I’m no expert, but I am part of the global diabetes community and read extensively about it, attend conferences, etc. I’m type 1, but sometimes, Type 2 can require more intensive treatment even when you do everything right. So, it’s not the fault of the patient. Sometimes, when blood sugars are elevated, we blame ourselves. My endos have always been super helpful, nonjudgmental and well informed on the new and latest treatments. It may take a while to get an appointment…..good luck with everything.

@sultanvr I can see that you know what "intrinsic kidney disease" means and some of the causes listed are " glomerulonephritis, lupus nephritis, acute tubular necrosis, certain antibiotics, and chemotherapeutic agents" as well as "interstitial nephritis."

I know my nephrologist explored the causes of a drop in my kidney function by talking about hydration, testing blood pressure and heart function (echocardiogram), and various autoimmune tests (I have a lupus diagnosis and high antibodies for scleroderma). From what I gather, autoimmune damage might be "intrinsic" but the other factors are external to the kidney itself.

I have also been told that the eGFR is influenced by many factors including muscle loss.
The Cystatin C version of the eGFR is more stable and mine is quite a bit higher than my creatinine based eGFR (the usual one). So maybe ask for a Cystatin C.

It sounds like the diuretic maybe dehydrated and hydration after stopping the drug has improved things. I don't know and your doctor can explain. That improvement is hopeful!

I have no idea if a doctor can tell it is "intrinsic" from urine tests. Have you had an ultrasound?

My kid has type 1 diabetes and other autoimmune issues but with type 2 you may not be dealing with autoimmune issues but maybe the nephrologist will do tests to rule that out.

Definitely see an endocrinologist and hope the nephrologist is helpful!

First suggestion: See the nephrologist and have him explain it to you. Intrinsic. i believe in this case may mean that "the way the kidney itself is functioning" and that the cause is not due to a secondary issue. That would be my interpretation. However, you should question the practitioner about clarification.

@sultanvr You have had some great responses here from fellow members! I had a response almost completed last night, then my phone hiccuped and it was lost. Dang it.

Basically, there is extrinsic [outside based] and intrinsic [internal based] descriptions of kidney concerns. Extrinsic could be from diet, dehydration, medicine interactions, comorbidities like diabetes or heart concerns. Intrinsic generally refers to internal causes like sepsis, PKD, disorders of the kidney itself. Here is a link to Oxford Academic where this is explained in depth: https://academic.oup.com/toxsci/article/164/2/379/5043549

Following a good renal diet of monitoring sodium, calcium, sugars, red meat, potassium, and phosphorous, plus keeping good hydration, can go a long way to helping the kidneys stay functioning as well as they can. While some medications by themselves may not be an issue, when used in combination with others there might be a negative interaction. Having a trusted pharmacist as part of your medical team could help you figure out if there is a combination of things that are contributing to kidney concerns.
Ginger

Thank you very much. This was very helpful.

My spouse had his appointment with the Nephrologist and she shared that our Primary Physician was wrong in that it was Intrinsic that it was Extrinsic, most likely due to Diabetes and High Blood pressure...and possibly some damage by meds/dehydration not being monitored. She was throwing a few different meds at us but was very reasonable listening to our concerns. We are on a "try this, delete that med" trial basis now for the next couple of months. I appreciate your advice about have a trusted pharmacist as part of our medical team. I'm going to be looking into that and looking into a different Primary Care Provider as well. I'm not trusting the one we have, based off of what we are learning.
Thank you again.

@sultanvr I'm glad to hear your feeling confident with the nephrologist. That's important! And the fact she is listening to your concerns is hopefully helping you feel more comfortable with the whole situation. Many of us with kidney disease issues find out that our primary care provider does not know/understand the important details of our kidney condition. For some reason, it is often underplayed in training.

Understanding that diabetes and high blood pressure are the two leading causes of kidney disease, address those concerns as top priority! Getting those under control will go a long way to helping the kidneys. My husband had uncontrolled/unmedicated high blood pressure, and was never told that condition could cause him kidney problems. He ended up on dialysis, with a transplant October 2016.

It may take a while to get things under control, and in some instances, may require a "testing" time, like your nephrologist indicated. If I may underline here, remember to follow a sound renal diet for your lifestyle and get/stay hydrated. There can be subtle changes that you will learn to recognize. Being compliant with the suggestions, writing down your questions, etc will be helpful. We as fellow members are here to share our experiences, not replace what your medical team will advise you. Ask your nephrologist if there is a Primary Care Provider that she could recommend.

And, we are here for you. Please let us know how we can help you!
Ginger