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Suggest Appropriate Treatment For Diabetic Nephropathy

Posted on Mon, 23 Nov 2015

Question: hi,

i have asked the question for my father suffering with Diabetic Nephropathy, i want to know what may be the reason for the fall in his Hb, he is on RPO 6000 once a week and now 6 injections were taken, current Hb is 8.6, Dr has advised for the bone marrow analysis and Immunofixation electrophoresis, please confirm is the treatment going in right direction? Dr has not given any haematinic yet.

Answered by Dr. Rakesh Madhyastha (4 hours later)

Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

First of all I disagree with your doctor's direction of treatment. As I can see with the attached PDF that his transferrin saturation is only 11% which means that he will require replenishment with IV/ oral iron and then RPO. Giving RPO without iron supplementation of little use.
Please get back to me with the latest serum creatinine and calcium values.

I dont think bone marrow analysis is required at the moment.

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Rakesh Madhyastha (3 hours later)

Hello sir,

thansk for your reply

latest value of

Calcium 9.6 (report date 9 oct 2015)

Sr Creatinine 3.1

also please suggest the oral iron supplementation with dose.

i have uploaded the reports, please review and suggest

Answered by Dr. Rakesh Madhyastha (27 hours later)

Brief Answer:
Seen the reports

Detailed Answer:
Hello

Thanks for getting back, I am sorry for the short delay in my reply it was a very long day at work

I have seen the reports, I usually start my patients on Tab Orofer xt twice a day, it contains 100 mg of elemental iron and folic acid as while. I repeat iron study after a month to see if the iron stores have improved. Transferrin saturation should be atleast 20%. If the patient iron stores does not improve then Intra venous iron therapy is required

I hope I was of help, if you have any further doubts please get back to me

Regards

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Rakesh Madhyastha (3 hours later)

Dear Dr

Have you reffered the attached reports....is there any observation?

Answered by Dr. Rakesh Madhyastha (8 hours later)

Brief Answer:
seen the report

Detailed Answer:
Hello

Thanks for getting back. I have gone through the reports and it indicates iron deficiency. Transferrin saturation is low which means that he will require iron replacement. Rest of the reports are within normal limits. There is no monoclonal band which means multiple myeloma is ruled out.

Regards

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Rakesh Madhyastha (33 hours later)

Dear Sir,

will the Oral Iron is effective or should i go for IV iron? since i am also a general practitioner i am skeptical about the reaction since i dont have the emergency setup at my clinic.

will the outcome same if i give him Oral Iron BD for 1 month?

Answered by Dr. Rakesh Madhyastha (12 hours later)

Brief Answer:
IV iron

Detailed Answer:
Hello

Good to know you are general practioner, I am always comfortable discussing patient issues with someone from our field.
I give my patients 500 mg of IV iron carbonyl ( encicarb) and most patients have tolerated it well. It has to be diluted in 100 ml of saline and given over 2-3 hours.
Renal failure patients have reduced capacity to absorb oral iron, that is why we prefer IV preparations. Outcome may vary, IV iron will replace the iron stores faster. Besides following iv iron they will be on oral iron once a day as maintenance

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Rakesh Madhyastha (4 hours later)

thansk dr will keep you updated.

Answered by Dr. Rakesh Madhyastha (19 hours later)

Brief Answer:
Regards

Detailed Answer:
Hello

I will be awaiting your reply

Regards

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Raju A.T