Stage 3 chronic kidney disease (CKD): What specialists do I see?

Posted by rozalia @rozalia, Aug 24, 2016

My primary says I do not need to see a kidney specialist. Is this true. My blood chems are ok.

@gingerw

@douglasbaker Welcome to Mayo Connect! I am sure you will glean a lot of information from this forum, as we all journey this road of kidney disease. Stage 3 generally breaks down in to "a" and "b" based on the eGFR because it runs from 29 to about 54 percent. The thing about kidney disease is that it can be pretty darned sneaky, and quietly affect your life before you exhibit many overt symptoms. It may be caused by lifestyle choices, genetically predispositions, medications used to treat other conditions, or in combination. It will be valuable for you to have information as to the cause.

The symptoms you describe may also be related to prostate health, so you might ask to see a urologist. We'll be here to answer questions as we can, based on our experience. When is your appointment?
Ginger

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Much appreciated

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Hi, i am 67 years old,male, my routine blood work at primary showed kidney GFR dropping below 60-he then referred me to a nephrologist, then to urologist for cat scans. I have cancer in the left ureter. GFR is 45 and i am now scheduled to have left kidney and ureter removed.This all happened in period of 4-5 months. Drs see a GFR under 60 as a red flag. Best wishes.

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first physician you should see is a nephrologist, he/she is a kidney specialist. The second individual if recommended by your nephrologist is a renal dietitician. Suggest that you ask your primary care doctor for his/her recommendation.

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In reply to @douglasebaker "Much appreciated" + (show)
@douglasebaker

Much appreciated

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@douglasebaker, do you have more questions? How are you feeling?

Hi @jim8086, welcome. Cancer in the left ureter must be rare. I'm glad that it was caught. Was GFR the only indicator of an issue? Did you have any other symptoms? Pain?

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@veteran1950

first physician you should see is a nephrologist, he/she is a kidney specialist. The second individual if recommended by your nephrologist is a renal dietitician. Suggest that you ask your primary care doctor for his/her recommendation.

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appointment made, thank you

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@colleenyoung

@douglasebaker, do you have more questions? How are you feeling?

Hi @jim8086, welcome. Cancer in the left ureter must be rare. I'm glad that it was caught. Was GFR the only indicator of an issue? Did you have any other symptoms? Pain?

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I will, but need to wait until after Nephrologist appointment. Thank you

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@colleenyoung

@douglasebaker, do you have more questions? How are you feeling?

Hi @jim8086, welcome. Cancer in the left ureter must be rare. I'm glad that it was caught. Was GFR the only indicator of an issue? Did you have any other symptoms? Pain?

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Voiding urgency, urologists first treated as "overactive bladder", went to second urologist who ordered cat scan which showed ureter was not functioning, then scope procedure verified cancer. Luckily it is a low grade cancer type with good prognosis, I had no symptoms except for rapidly declining gfr on blood work. Thank God I changed dr and went to Mayo Clinic, cant say enough good things about them!

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I have recently been diagnosed Stage 3B CKD. It is frustrating because I have had GFR and creatinine levels out of wack for some time but my internist for the last 15 years has always told they are my norm. I was seen at Mayo last April for a GI issue and the next time I saw my internist he asked me what Mayo said about my kidneys. I was in shock. I quickly saw a nephrologist at the University of Iowa and received my diagnosis. I received no guidance on diet at all. I have researched on my on using PubMed and the like and from what I can see at Stage 3 I should be limiting sodium to under 1500mg and protein to under 65g based on my weight. For right now is there anything else I should be doing. My blood pressure has crept up recently and I am now on 7.5mg of Amlodipine. I was prescribed 10MEQ potassium citrate based on a 24 hour urine and an ultrasound showing a fairly large kidney stone in one kidney and a cyst in the other. I am on 20mg Atorvastatin for cholesterol recently and take 40mg Pantaprazole for my GI issues. Any advise for what I should be doing in regards to diet other that the sodium and protein restriction? I am glad I found this discussion group and wish everyone well.

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Welcome, @gladiator14! These are great groups. Like you, I had little dietary guidance even after seeing a neph so, like you, had to do some research on my own. Below is an excerpt from a recipe collection I gathered for renal patients citing NIH and ADA guidelines. This is not medical advice in any way, it's just what I was able to find out at the time and may no longer be the norm.

Two and a half years ago this home cook received the devastating news that one kidney had atrophied and there remained about 27% function in the other.
One of the first considerations that came to mind was diet. The result of researching kidney-friendly foods was a collection of recipes for kidney patients, DIABETIC AND RENAL FRIENDLY VEGETARIAN-ALMOST-VEGAN RECIPES with approximate nutrient values for each dish.

For several reasons, it might be wise to recheck values given there, valid at time of writing but perhaps no longer accurate.

First, nutrient amounts in that collection as well as in YES are approximate values; recipes calling for such ingredients and nutrient totals are suggestions only.
Second, since permission to include some companies’ brand names has not been obtained, generic descriptions of certain products have been given. When shopping for those items, comparing product label information to the nutritional values appearing here is strongly recommended.
Third, cooking sometimes modifies nutritional totals, some of which are increased while others decrease. Also, many USDA values are for raw foods, others are for cooked servings. Fourth, rinsing, draining then soaking and again rinsing and draining (and, if
possible, parboiling, rinsing and draining) can reduce some phosphorus, up to 40% (perhaps more) of the potassium, 33-89% sodium, depending on the product. Fifth, manufacturers sometimes change ingredients or amounts which then alters
values from what one previously might have read on product packages. Sixth, food producers are not required to list phosphorus content on labels and
most do not. (However, while some do not assay phosphorus, others do know how much a food has and usually will share that information with the consumer when asked.) Seventh, one brand of a product may contain different nutritional values from those in another similar, brand. Hy-Vee® store brands are among the preferred ingredients here but other brands can be substituted as long as recipe nutrient values are adjusted accordingly.

So, it behooves a CKD shopper to read labels, perhaps every time an item is purchased.

The NIH and the USDA are credible sources for nutrient values. It’s worth noting, however, that the USDA’s Global Branded Food Products Database includes values for some nutrients in branded and private label foods that appear on brand name product labels themselves, which are provided from the food producer’s own data.

Some USDA nutrient figures, including but not restricted to those confirmed by the manufacturers themselves, might lead the researcher to conclude that at
least a few common dietary recommendations/restrictions for renal patients in the past can be questioned, depending on type and stage of the disease process. Recommended amounts of nutrients, particularly protein and minerals such as phosphorus, potassium, and sodium, vary according to disease status/progression and vary according to whether a person is pre-dialysis or receiving dialysis; amounts recommended also vary from expert to expert.

Daily values for pre-dialysis stages 1-3 CKD recommended by the NIH are 800 to 1200 mg phosphorus, 1500 to 2700 mg potassium, 2000 to 3000 mg sodium, and 0.36 grams of protein per pound of body weight.

Phosphorus is a necessary part of any healthy diet but for CKD patients too much can cause itching, dry skin, bone density loss, and more. Some experts call for limiting phosphorus to 1,000 mg per day while others suggest 700-800 mg or less daily and still others say 500 mg is the best target amount.

Recommended potassium intake varies from group to group, too. At stage3b CKD, some dietitians or nephrologists limit potassium to 1500-<2000 mg daily.

The American Heart Association suggests using far less sodium,1500 mg or 1.5 grams a day instead of the common 2-gram daily restriction of the recent past. (Before deciding how much or how little sodium one should consume each day, it would be wise to consult one’s care team regarding sodium intake.)

Most experts favor less protein for persons with CKD (than the larger amounts healthier people can process,) sometimes 35 grams daily, perhaps lower.

Sources/Resources

American Diabetes Association
American Heart Association
Adventist Health Studies
American Journal Of Clinical Nutrition
American Kidney Fund
Cleveland Clinic
Daiya Foods
FDA
Follow Your Heart®
Go Veggie®
Hy-Vee® Stores, Inc/Hy-Vee® brands
La Preferida®
Mayo Clinic Community Support Groups
National Kidney Foundation
NIH
nutritiondata.self.com
Tofutti® Brands, Inc
University of Chicago
USDA

If you can, get your nephrologist to refer you to a renal dietitian. Also, if you're interested, my research and recipes are available in pdf format free of charge and I can post them to you here whenever you like.

Again, welcome to the group. Hope and love live here.

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As a CKD patient myself since 2011, also stage 3B, as was mentioned by kamama94, seek the immediate help of a renal dietitician. He/she will remove all the guesswork/frustration of shopping for the appropriate foods for your stage of CKD. If, by any chance your nephrologist doesn't think your condition doesn't require a renal dietitician, then go out on your own to obtain a qualified person. As was mentioned previously by kamama94 their are many sources to turn to for professional guidance.

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@kamama94

Welcome, @gladiator14! These are great groups. Like you, I had little dietary guidance even after seeing a neph so, like you, had to do some research on my own. Below is an excerpt from a recipe collection I gathered for renal patients citing NIH and ADA guidelines. This is not medical advice in any way, it's just what I was able to find out at the time and may no longer be the norm.

Two and a half years ago this home cook received the devastating news that one kidney had atrophied and there remained about 27% function in the other.
One of the first considerations that came to mind was diet. The result of researching kidney-friendly foods was a collection of recipes for kidney patients, DIABETIC AND RENAL FRIENDLY VEGETARIAN-ALMOST-VEGAN RECIPES with approximate nutrient values for each dish.

For several reasons, it might be wise to recheck values given there, valid at time of writing but perhaps no longer accurate.

First, nutrient amounts in that collection as well as in YES are approximate values; recipes calling for such ingredients and nutrient totals are suggestions only.
Second, since permission to include some companies’ brand names has not been obtained, generic descriptions of certain products have been given. When shopping for those items, comparing product label information to the nutritional values appearing here is strongly recommended.
Third, cooking sometimes modifies nutritional totals, some of which are increased while others decrease. Also, many USDA values are for raw foods, others are for cooked servings. Fourth, rinsing, draining then soaking and again rinsing and draining (and, if
possible, parboiling, rinsing and draining) can reduce some phosphorus, up to 40% (perhaps more) of the potassium, 33-89% sodium, depending on the product. Fifth, manufacturers sometimes change ingredients or amounts which then alters
values from what one previously might have read on product packages. Sixth, food producers are not required to list phosphorus content on labels and
most do not. (However, while some do not assay phosphorus, others do know how much a food has and usually will share that information with the consumer when asked.) Seventh, one brand of a product may contain different nutritional values from those in another similar, brand. Hy-Vee® store brands are among the preferred ingredients here but other brands can be substituted as long as recipe nutrient values are adjusted accordingly.

So, it behooves a CKD shopper to read labels, perhaps every time an item is purchased.

The NIH and the USDA are credible sources for nutrient values. It’s worth noting, however, that the USDA’s Global Branded Food Products Database includes values for some nutrients in branded and private label foods that appear on brand name product labels themselves, which are provided from the food producer’s own data.

Some USDA nutrient figures, including but not restricted to those confirmed by the manufacturers themselves, might lead the researcher to conclude that at
least a few common dietary recommendations/restrictions for renal patients in the past can be questioned, depending on type and stage of the disease process. Recommended amounts of nutrients, particularly protein and minerals such as phosphorus, potassium, and sodium, vary according to disease status/progression and vary according to whether a person is pre-dialysis or receiving dialysis; amounts recommended also vary from expert to expert.

Daily values for pre-dialysis stages 1-3 CKD recommended by the NIH are 800 to 1200 mg phosphorus, 1500 to 2700 mg potassium, 2000 to 3000 mg sodium, and 0.36 grams of protein per pound of body weight.

Phosphorus is a necessary part of any healthy diet but for CKD patients too much can cause itching, dry skin, bone density loss, and more. Some experts call for limiting phosphorus to 1,000 mg per day while others suggest 700-800 mg or less daily and still others say 500 mg is the best target amount.

Recommended potassium intake varies from group to group, too. At stage3b CKD, some dietitians or nephrologists limit potassium to 1500-<2000 mg daily.

The American Heart Association suggests using far less sodium,1500 mg or 1.5 grams a day instead of the common 2-gram daily restriction of the recent past. (Before deciding how much or how little sodium one should consume each day, it would be wise to consult one’s care team regarding sodium intake.)

Most experts favor less protein for persons with CKD (than the larger amounts healthier people can process,) sometimes 35 grams daily, perhaps lower.

Sources/Resources

American Diabetes Association
American Heart Association
Adventist Health Studies
American Journal Of Clinical Nutrition
American Kidney Fund
Cleveland Clinic
Daiya Foods
FDA
Follow Your Heart®
Go Veggie®
Hy-Vee® Stores, Inc/Hy-Vee® brands
La Preferida®
Mayo Clinic Community Support Groups
National Kidney Foundation
NIH
nutritiondata.self.com
Tofutti® Brands, Inc
University of Chicago
USDA

If you can, get your nephrologist to refer you to a renal dietitian. Also, if you're interested, my research and recipes are available in pdf format free of charge and I can post them to you here whenever you like.

Again, welcome to the group. Hope and love live here.

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Kamama94. As usual, job well done, Kamama. While I understand these are tough times generally for everyone, I'm having a particularly difficult time buying food from major grocery stores in my area. Although extremely high risk, I cannot avoid grocery shopping in person. When I tried delivery or pickup services, I frequently received fresh food on the brink of spoilage. Once, I was sent an out-of-date turkey breast. Also, many items on my list are frequently "out-of-stock," although I've no way of knowing that until I have received my order. So, with my limited diet, trying to cook for my husband, and arthritic fingers, I'm looking for suggestions on how to procure food. Does anyone know of a meal delivery service whose meals include diabetic/kidney friendly choices?

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@trishanna

Kamama94. As usual, job well done, Kamama. While I understand these are tough times generally for everyone, I'm having a particularly difficult time buying food from major grocery stores in my area. Although extremely high risk, I cannot avoid grocery shopping in person. When I tried delivery or pickup services, I frequently received fresh food on the brink of spoilage. Once, I was sent an out-of-date turkey breast. Also, many items on my list are frequently "out-of-stock," although I've no way of knowing that until I have received my order. So, with my limited diet, trying to cook for my husband, and arthritic fingers, I'm looking for suggestions on how to procure food. Does anyone know of a meal delivery service whose meals include diabetic/kidney friendly choices?

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@trishanna, As a high risk individual, I have found a way to shop for groceries that is working well for me. I schedule my grocery pick-up for 8am (earliest one) and that order is for my heavy, stable products. I go early for my pickup when the store opens at 7am and pick out my veggies, fruits, meats etc. The store is almost empty, it is easy in/easy out before I drive around the building to get my pick-up order.

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