When do I need a nephrologist?

My Primary Care is the one that sent me to a Nephrologist. It took a long time as she was watching my A1C slowly climb even with proper meds that should have been controlling diabetes and had previously worked fine.
Make sure your primary is aware of your concerns. Let him/her explain to you why another opinion is not needed.

@joefriday49 you should not be taking contrast at all. My doctors all agree on that. The tests can be done without it.

Just because many Primary docs don’t address CKD early on does not mean that we can’t do anything about it…hydration and dietary adjustments help—there’s a lot of info here about that and on reputable web sites like Mayo and Cleveland Clinic. Beware, there are a lot of hucksters out there promoting ‘’cures’’…. Wishing you the best.

@nancy4058
Being a long term cancer survivor both my surgeon and oncologist prefer contrast, simply because it makes abnormalities easier to notice. (or so I'm told)
Also I recently failed a Heart Cath procedure because of lack of visual detail, due to using minimal amount of contrast... But a few days later I had open heart surgery to replace 3 plugged arteries. Stents would have probably not done very well anyway as all of them were more than 90% occluded.
So I question contrast every time I have a procedure and turn it down each time they can do without it.

@joefriday49 there are alternative contrasts….my docs don’t order them as my kidney #s are not too bad…but, I requested IV hydration, to be done right after the CT with contrast, and felt much better. Also, hydrate extra on your own. Meanwhile, i hope you feel better.

Getting more information from another source is never a bad idea. In your case a nephrologist. The more information we have the better decisions we are able to make. I have posted this before but it bears repeating. “Less than 2% of those diagnosed with CKD go on to kidney failure.” Look it up. Do not take my word for it.

I was diagnosed eGRF of 3B close to 2A back in 2014. I have had a liver transplant in 2000 and my immune surpressant, Tacrolimus, can cause kidney damage. I had another liver transplant in 2017 also. Kidneys still around the 3A for years now. I had a Nephrologist since 2014. I get tested annually. Go and get a regular test. I was told that if it goes down to eGRF 2 then they will look into it further. I never had a rejection episode with my livers so far so I ask my Heptologist to keep my Tac levels as low as possible now.

@dougr19 kidney transplants are the largest group of transplant patients on the UNOS Transplant List and patients typically wait is over 1 year. So the longer a person waits the worse it will get. Plus the listing are by blood type per organ type. A and B blood type wait the longest, followed by O. AB have much shorter waits since this blood type represents around 3% of the population. Plus AB type can receive type A, B, and O blood type organs.

I was sent to see a nephrologist when my creatinine, which had been creeping up for years, approached 1.0. I'm glad my PCP was cautious because my first 24 urine collection showed total protein at 4,500 mg (normal is below 300 mg). After I did a number of other tests, I had a kidney biopsy. My local HMO lab lacked a reagent for a test they planned to do so they sent it to the Hennepin County Medical Center in Minneapolis which also lacked that reagent. The County Hospital lab sent it the the Nephrology and Hypertension lab at the Mayo Clinic in Rochester where the test was done but triggered an electron microscopic study of the sample. The pathologist diagnosed immunotactoid glomerulopathy (ITG). I have read that an international team has found only about 100 people worldwide with that diagnosis. About 70% have lymphoma and when the lymphoma is treated, the ITG also responds. About 30% also have myeloma which has no cure. When ITG patients with myeloma go into myeloma remission, their ITG also improves. I am one of an estimated 10 people worldwide with ITG but who do not have either lymphoma nor myeloma. The nephrologist said that patients like me typically require dialysis in about four years. I read that dialysis is typically only effective for about three years. I was diagnosed in five years ago this month. My most recent creatinine was 0.82 but 24 hr protein is still nearly 5,000mg. More treatment is under discussion. My nephrologist considers me to be in Stage 2 or 3A.

@nycmusic I researched here and elsewhere, worked out what is a modified version of the kidney diet(I have other issues needing my attention), and in 3 months raised my eGFR by 10 points and brought down my creatinine…will need to stay vigilant to maintain more normal kidney #s….so it’s possible—just takes some focus and effort.