Mayo Clinic Connect
My primary says I do not need to see a kidney specialist. Is this true. My blood chems are ok.
Liked by cehunt57
@rozalia, would you tell us a little about your medical issue? I’m a stage-3 CKD myself under careful watch by my primary care physician AND my nephrologist, as well as my urologist. What caused you to consider asking for a kidney specialist (nephrologist)? Was it a low filtering percentage as calculated from your lab test? Was it high blood pressure for which nephrologists are a good referral? Were you experiencing palpable symptoms from CKD? Might the expense of a referral have been a factor in your primary’s advice?
Liked by Colleen Young, Connect Director, cehunt57
Good questions @predictable! I’m also tagging @rosemarya on this discussion.
Welcome @rozalia. I hope you’ll tell us a bit more about you. We look forward to helping you find answers to your questions as you navigate chronic kidney disease and the health care system.
Liked by Ali Skahan, cehunt57
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Iam 79 years old and was diagnosed with stage 3 ckd five years ago . My primary keeps tabs on my blood work and since I have stayed at the same level for five years he feels no need to see a neprologist. I take carvedilol,amlodipine and lisinopril for hypertension. Iam on no special diet except for watching my sodium.intake. I wonder if I should be doing more.
Right now my cardiologist has been managing my BP meds. It took a lot of tuning to get the results he wanted which is a systolic below 130. My primary would prefer a higher reading because he worries about the times it has gotten as low as 90/50. So I am not sure what is the best. I have had no symptoms of CKD which by the way my brother also had..I have excellent health insurance.
@rozalia, you and I are almost twins with our CKD, hypertension, and medications (although our dosages may differ). I’m curious about why you were prescribed Carvedilol (a beta blocker) and Amlodipine (a calcium channel blocker) at the same time; I used the latter then switched to the former. Lisinopril and I have been friends for years! Dosages for me are Carvedilol (25mg twice a day), Lisinopril (40 mg once). My third medication is Amiloride (10mg twice a day) as a diuretic; it signals my main difference with you — a potassium-sparing diuretic that accommodates a genetic tendency in my kidneys that fails to reclaim potassium after filtering it out with sodium.
The dispute you cite — regarding the proper target level for your BP — is mine as well, involving the same specialists. My nephrologist favors higher targets for me (an “elderly” 81) than my cardiologist, although he has not challenged the higher targets of 140/90 or less. My primary also accepts my preference for nephrology in dealing with BP.
Your primary sees no role for nephrology in your stable CKD and yields to your cardiologist on BP. In my case, nephrology is the priority specialty on BP, and cardiology is focused especially on the heart and my circulatory system. In one sense, I see an advantage for you in the tension between cardiology and nephrology. Do you think your primary sees nephrology dealing with familiar kidney functions only, not including blood pressure?
My lab tests are ordered mainly by my primary physician to maintain a data base on me; neither specialist has ordered lab tests for three years. All agree that my CKD is stable and unremarkable, and I don’t have any symptoms from it. Now if my medical team can figure out what problem a-fib is causing, I’ll be totally under control of my physical condition.
Liked by cehunt57, kamama94
I think my primary knows I prefer the lower BP readings so he goes along with it . However I only see the cardiologist once a year and the primary every 4 months so at times I feel he should really be handling the BP meds. The cardiologist put me on the amlodipine because my BP kept spiking high in the late afternoons 150/90 or higher. I really don’t care for it because it causes my feet to swell up, one of it’s side effects. Do you ever feel like just saying the heck with it all . I mean I get frustrated with these doctors at times. But then again were would we be without them. Hope you get some answeres to your a-fib problems. I get those on occasion, when I am stressed out or tense.
Once more, we’re on the same page, @rozalia. I quit amlodipine for reasons of swelling feet and ankles. I had used calcium-channel blockers before without such problems, but after a-fib the swelling began. Fortunately, a-fib sped up my heart rate so I had room to use Carvedilol, a beta blocker that slows the heart rate. Spiking BP in the late afternoon is common when meds are not split between morning and afternoon. I take mine in about equal doses after breakfast and after dinner (with food as directed). Lisinopril, however, is a bedtime med along with Coumadin and a baby aspirin. Using the 24-hour BP monitor one day, I found my BP ran around 138/90, but spiked to 150/90 for no apparent reason; it jumps around a bit all day, and that’s not unusual.
I haven’t felt like walking away from my doctors (except for a couple of cardiologists who didn’t know much about BP). My nephrologist bored in on the cause of my hypertension and, with the help of an endocrinologist, found an inherited kidney defect; that discovery will probably extend my life. I get up in the morning now and ask myself, “What am I going to do for the next 20 years?”
Maybe I should consider seeing a nephrologist about my problem. As I mentioned before my brother suffered from kidney disease and high BP also and was followed by a nephrologist. His kidney function was worse the mine and started at a much younger age. He died in a accident five years ago. I think I’ll bring it up when I see my primary next month.
Liked by Rosemary, Volunteer Mentor, Martin Jensen, Volunteer Mentor
A second opinion and another voice sounds like a win-win situation. At the very least, you can enjoy some peace of mind by getting your concerns addressed. Hope it all happens smoothly for you. Rosemary
Liked by Ali Skahan
Thank you for your encouragement. It certainly can’t hurt to ask,I don’t think my primary should take it the wrong way.
I can not go to a nephrologist until stage 4 in Canada,our government medical does not allow it. I see a dietitian for free in 3 weeks at my local hospital. I am 54 and 2 years a go my kidney function was 92%, 4 months a go 70%, 3 months a go 70%. It is considered a problem to change so fast and I am arranging to get some blood tests on this. It is considered a problem if it changes 10% a year, even if in the normal range. I have 3 blood clots in one lung, 3 months a go found out my kidneys are not producing the hormone that makes hemoglobin and was given a hormone replacement shot and Iron pills. My blood tests showed white and red blood cells were both damaged,wrong shape and size and not enough of both. I am on Xarelto for 3 blood clots in one lung from 3 months a go and will arrange on my own for blood tests to see if improved. I was told to add salt daily to keep my blood pressure at 96/65 otherwise it is 80/60 daily and 120 with no exercise for 3 days and immediately down after my gym class. If I exercise daily blood pressure is the same before and after exercise. Maybe it is all kidney related.??
@lindaw, I’m surprised that you cannot see a nephrologist in your province until you are Stage 4. Which province do you live in?
Here is information about referrals from the Kidney Foundation of Canada https://www.kidney.ca/information-and-referral Perhaps you could contact them to get more information.
Liked by Kelly, Alumna Mentor, Martin Jensen, Volunteer Mentor, Kanaaz Pereira, Connect Moderator, cehunt57
Hi, @lindaw. I saw your two other messages on the Diminished Kidney Function discussion and want you to know that we at Mayo Connect get related to people like you and want to help in some small way to smooth your path to feeling better and gaining strength.
Your last question points directly at my primary advice: Find out if your kidneys are at the core of your problems as soon as you can. That answer probably would come from a nephrologist. In cases of kidney failure, a dietician is usually called in to get that side of your therapy in order, but nephrology and endocrinology may be where your problem can be defined concretely — endocrinology because of the hormone involvement you have and because your hypotension may be related to hormones that involve your kidneys and the adrenal glands attached to them.
The cause of your blood clots also needs concrete definition. Has your medical team explained what might have caused them and what steps to take — beyond an anti-coagulant medication — to protect you in the future?
I also wondered whether you are bearing the major responsibility for finding out how to diagnose your conditions and treat them. I’d be lost if I tried to assume that much responsibility. I do enough research and consultation that I can come up with relevant questions for medical professionals to answer, but I don’t let them off the hook on the main medical questions. I expect them to give me the best medical advice, as well as treatment, that they can, and I try to develop a relationship with them in which they feel primary accountability for diagnosis and therapy. And I soon let them know that I prefer to search for cures not for simply maintenance nostrums. This has worked for me; my doctors have all thanked me for keeping up on the medical issues and therapy choices.
Please keep us abreast of your journey through medical care. We want to see you get on the upward road to tomorrow.
Liked by Colleen Young, Connect Director, Kanaaz Pereira, Connect Moderator, cehunt57
I am also CKD stage 3 and a Type 2 diabetic. My GP put me in touch with a nephrologist and a cardiologist. The GP maintains my BP prescriptions but consults the two specialists. I take Amlodipine (lowest dose and have not had swelling), a diuretic, Metoprol, and Losartan. My BP is still not where it should be which I know is vital to my kidney health. My diabetes is in control with an A1c of 6.5. I monitor my blood pressure and blood glucose at home twice a day. I don’t understand the choice of BP meds as they are not what is recommended for CKD. Your thoughts?
Hi, @riveroaksfarm, welcome to Mayo Connect and this large community of people experiencing one or another of untold numbers of maladies, medical responses, second opinions, and after-care prospects. I’m intervening here because of similarities with your situation and uncertainties, and you might find something worthwhile.
I am CKD stage 3 with hypertension, but not diabetic. I get treatment from an internist, a cardiologist, and a nephrologist. My nephrologist is captain of my care (so far as I am concerned) and often consults with an endocrinologist on kidney-affecting hormones. My cardiologist is interested mainly in my a-fib, which has me on Coumadin anticoagulant but without any symptoms.
My primary BP medication for 30 years has been one diuretic after another. Amlodipine lasted only a short time because of swelling in my extremities, a common and vexing side-effect. My diuretic now is Amiloride, a potassium-sparing medication that I need to maintain the right potassium level. I am also on Lisinopril (an ACE inhibitor related to your Losartan) and Carvedilol (a beta blocker related to your Metoprolol). These meds keep my BP pretty stable after years of raging up and down and up again. Diet and exercise are crucial factors also.
Altogether over those 30 years, doctors have experimented on me with some two dozen medications (I won’t bore you with the details, only say that most were dropped after failing to do the job, but if you want to ask me about any specific med, I’ll gladly respond). My nephrologist is unique in that she wasn’t simply searching for a medication that would help — she went after the cause(s) of my symptoms, and she found them in my DNA (my genetics).
Therein is my primary advice: Ask your medical team for tests under the new discipline known as Pharmacogenomics, which examines your DNA comprehensively to identify which medications are most likely to be effective, given your genetic makeup. If possible, insist on this, and get back to us if you want to proceed along this line and need some external contact information to access the tests. In the meantime, perhaps you can get your GP or your nephrologist to explain the risks you face taking your three primary medications. Get back to us any time if you think we can help.
Liked by Rosemary, Volunteer Mentor, Jamie Olson
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