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What Are The Symptoms Of Kidney Damage?
Question: Yes, thanks. Six months ago my 92 year old father was diagnosed with stage 4 (?) renal disease due to Hydronephrosis (scarring after treatment for prostate ca). His GFR was 15, but after removing Diovan, adding other HBP meds, and inserting a catheter, it went up to 37.5. Was told his renal functioning would decline, most likely within a year or less.
At the time of diagnosis, he was beginning to nod off while talking with others and beginning to say some odd things. He has slept many, many hours a day for past 5 - 6 years due to central apnea and continues to do so. He continues to be very fatigued.
Rapid Response ua test strips indicate XXXXXXX Leucocytes, along with XXXXXXX Red Blood Cells. Protein, however, shows only minimal increase. Specific gravity has been hovering around 1.010 and is now remaining there.
Pops' waist has increased greatly in girth although his weight has not changed at all. Possible ascara but not ascites. Edema in feet and ankles. BP continues to go up.
In recent weeks, he has begun having "blow-outs" (diarrhea in Depends) several times a week. Urine in XXXXXXX tube has been opaque at times and appears to have sediment.
My observations lead me to believe he is near to entering ESRF, but the low protein reading in the ua test strips confuses me.
Knowing what to expect is one of my best defense mechanisms.
Do you think Pops is close to (within a month or so) entering ESRD?
Papi's appetite was poor at time of diagnosis and he often ate only dry cereal with milk and/or soup. Appetite improved some with treatment, but appears to be waning again.
Urine color was initially golden. Pops (a retired Internist) prefers to not drink much in the way of fluids - think he wants to protect his kidneys but he doesn't say. Recently it appears his urine is getting lighter. I know typically one is told urine will become tea-colored, but I believe it can also possibly become clear as it did in the case of my dog who was put down due to renal failure.
Urine output has not been measured by facility.
Very dark circles around both of his eyes have appeared recently.
At time of diagnosis he was frequently regurgitating his dinner, but claimed he did not feel nauseated. These symptoms went away fairly quickly after treatment began. Last week Pops thought he was about to regurgitate again, but was able to keep his dinner down.
He had back "cramps" (he said from simply sitting in one place for too long) at time of diagnosis. These went away, but a few days ago his had a severe back cramp after sitting for a long time.
Hospice in in place, and I am comforted by knowing that agitation, seizures, hallucinations, pain, and breathing can be treated to provide minimal distress to Papi.
Pops has many co-morbid conditions..."mini-strokes" that had taken his hearing, given him double vision, central apnea, total lack of balance, weakness. He is able to stand with help (placing crook of elbow under one of his armpits). Is very weak. Must have help simply getting legs up on bed when he lies down.
Despite all this, Papi is a very determined, strong-willed man!
Cognitive functioning is still remarkably great...but he has lately begun to watch Disney sitcoms...he absolutely HATED sit-coms in the past. ;-)
Diagnosis came after Pops developed *extreme* edema in feet, legs, and thighs and I asked him to take a diuretic as his doc had instructed prn. His BP plummeted and the "house" doc at his ALF did bloodwork.
Although he has been cold (as are all his fellow residents), the temp in his apartment is toasty (far too warm for me). With summer here, he still says he feels a little chilled at times. Lately, while lying next to him, I've felt his forehead...it has felt clammy and damp. Haven't taken his temp...he insists he has not fever.
Oh, yes...he had endarterectomy at age 50, but completely changed his diet for the better. Had been working out at the "Y" for about 30 years. Stopped going in August of last year - of course he needed help to get on weight machines and the weights were very light. Collapsed in September while using walker and has been in WC since.
At the time of diagnosis, he was beginning to nod off while talking with others and beginning to say some odd things. He has slept many, many hours a day for past 5 - 6 years due to central apnea and continues to do so. He continues to be very fatigued.
Rapid Response ua test strips indicate XXXXXXX Leucocytes, along with XXXXXXX Red Blood Cells. Protein, however, shows only minimal increase. Specific gravity has been hovering around 1.010 and is now remaining there.
Pops' waist has increased greatly in girth although his weight has not changed at all. Possible ascara but not ascites. Edema in feet and ankles. BP continues to go up.
In recent weeks, he has begun having "blow-outs" (diarrhea in Depends) several times a week. Urine in XXXXXXX tube has been opaque at times and appears to have sediment.
My observations lead me to believe he is near to entering ESRF, but the low protein reading in the ua test strips confuses me.
Knowing what to expect is one of my best defense mechanisms.
Do you think Pops is close to (within a month or so) entering ESRD?
Papi's appetite was poor at time of diagnosis and he often ate only dry cereal with milk and/or soup. Appetite improved some with treatment, but appears to be waning again.
Urine color was initially golden. Pops (a retired Internist) prefers to not drink much in the way of fluids - think he wants to protect his kidneys but he doesn't say. Recently it appears his urine is getting lighter. I know typically one is told urine will become tea-colored, but I believe it can also possibly become clear as it did in the case of my dog who was put down due to renal failure.
Urine output has not been measured by facility.
Very dark circles around both of his eyes have appeared recently.
At time of diagnosis he was frequently regurgitating his dinner, but claimed he did not feel nauseated. These symptoms went away fairly quickly after treatment began. Last week Pops thought he was about to regurgitate again, but was able to keep his dinner down.
He had back "cramps" (he said from simply sitting in one place for too long) at time of diagnosis. These went away, but a few days ago his had a severe back cramp after sitting for a long time.
Hospice in in place, and I am comforted by knowing that agitation, seizures, hallucinations, pain, and breathing can be treated to provide minimal distress to Papi.
Pops has many co-morbid conditions..."mini-strokes" that had taken his hearing, given him double vision, central apnea, total lack of balance, weakness. He is able to stand with help (placing crook of elbow under one of his armpits). Is very weak. Must have help simply getting legs up on bed when he lies down.
Despite all this, Papi is a very determined, strong-willed man!
Cognitive functioning is still remarkably great...but he has lately begun to watch Disney sitcoms...he absolutely HATED sit-coms in the past. ;-)
Diagnosis came after Pops developed *extreme* edema in feet, legs, and thighs and I asked him to take a diuretic as his doc had instructed prn. His BP plummeted and the "house" doc at his ALF did bloodwork.
Although he has been cold (as are all his fellow residents), the temp in his apartment is toasty (far too warm for me). With summer here, he still says he feels a little chilled at times. Lately, while lying next to him, I've felt his forehead...it has felt clammy and damp. Haven't taken his temp...he insists he has not fever.
Oh, yes...he had endarterectomy at age 50, but completely changed his diet for the better. Had been working out at the "Y" for about 30 years. Stopped going in August of last year - of course he needed help to get on weight machines and the weights were very light. Collapsed in September while using walker and has been in WC since.
Brief Answer:
Yes, I think close
Detailed Answer:
Hello,
Thanks for posting your detailed question, I understand your concern.
Several signs here are indicative that he may soon (within the next year) need dialysis. Now we cannot predict the future, but it is best to prepare yourself for this.
The signs include his elevated blood pressure in the setting of persistent edema in his feet, show a sign of poor clearance and the pressure will further damage the remaining kidney function.
I wouldn't hold much weight in the strips as they are not very accurate and cannot be trusted.
I hope this helps you, please do write back if you I have not addressed any specific question of yours.
Kind regards.
Yes, I think close
Detailed Answer:
Hello,
Thanks for posting your detailed question, I understand your concern.
Several signs here are indicative that he may soon (within the next year) need dialysis. Now we cannot predict the future, but it is best to prepare yourself for this.
The signs include his elevated blood pressure in the setting of persistent edema in his feet, show a sign of poor clearance and the pressure will further damage the remaining kidney function.
I wouldn't hold much weight in the strips as they are not very accurate and cannot be trusted.
I hope this helps you, please do write back if you I have not addressed any specific question of yours.
Kind regards.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you so much for writing back, Dr. Vora.
I know I am a real neurotic and a pain in the butt about this!
Papi has chosen to have no extraordinary care...in others words, no dialysis.
By the way, I think I told you his GFR when first diagnosed was 15, but I believe it was actually 20, then after treatment went to 37.5. When he was diagnosed and before my father himself brought up the possibility of having Hydronephrosis and a catheter was placed, his doc told us to be prepared for him to live between several weeks and two months.
I know you cannot predict the future, but ***I am hoping you can give me a *more clear prognosis* in terms of *realistic* time left***. I love Papi very much AND I think I am prepared for his death as much as I can be. Having a better idea of when ESRD might begin would ease my anxiety. Obviously I am depressed, sad, and anxious, but I am enjoying the remaining time I have with Papi. Obviously watching him deteriorate is very distressing.
Papi has become more subdued and tired, and doesn't speak often. He still wishes to go on living. He closes his eyes at the dinner table while he waits for his dinner to be served or most any time when he is not watching TV or reading the newspaper. He seems very fatigued, but not yet *quite* as sleepy and fatigued as he was when his GFR was at 20 or so. He sleeps for approximately 17 hours a day, but has done that for several years, probably due in part to central apnea. He is extremely weak...is able to sit up in bed on his own by pulling himself up with a grip bar, but is unable to raise his feet and legs into the bed. Because it makes him happy, I "walk" him (support him and guide him) from his bed to his easy chair, and he seems to have lost strength in the past week or two weeks. If I had to compare what he seemed like now to how he seemed at the time of diagnosis, I would say he is *almost* back to the same physical and mental state.
What would help me most right now would to have as *realistic* an idea as possible of what to expect in the future. After having been with Papi for six years, and having observed him and changes in him very, very closely for so long (and having seen symptoms building up prior to his diagnosis of RD), I have a pretty good sense that ESRD may begin within the next month or so. I continue to make mental notes of what may seem to be very insignificant changes, but when all put together, they seem significant.
Is there something besides a ua test strip I can use to have a better idea how far along he is in terms of renal disease? Perhaps Rapid Response Micro albumin / Creatinine Urinalysis Reagent Test Strips? I know they are not perfect, but *anything* to help me understand where he is on the renal disease continuum would be better for me than nothing. It is so hard to be with Papi 8 hours a day and slowly watch him deteriorate and wonder how long he will go on this way.
I certainly would not expect you to know for sure or say with any certainty when ESRD might begin since you have not examined him, don't know his medications, etc.
By the way, he takes:
Zoloft 50 mg 1/AM
Flomax 0.4 mg 1/Daily
Metoprolol (spelling?) 50 mg/AM
Lisinipril (spelling?) 5 mg/AM
Hydrocodone 5 mg codiene with 325 mg Tylenol 1/PM for what is thought to be arthritis pain (severe) in left foot
Hydolozine (spelling?) 5 mg/AM which just today was increased to 10 mg due to HBP and 10 mg/PM which was increased from 5 mg/PM about 2 - 3 weeks ago due to HBP.
His blood pressure this morning was 199/106 and frequently has been high in the AMs, hence the increase.
Last week his PM blood pressure ranged from 140 - 170 / 60 - 80. Last night it was 107/54.
Since he is in hospice, he does not have blood work done for diagnostic purposes. His physician could, if he wanted to, have blood work done, but sees no need to do this, and also, then Pops would want to know the results, and at this time he seems to need to be in a bit of denial. Since his doctor told me in January of this year that he could live possibly another year, I already know that.
Questions:
Is my intuition (based on being "tuned in" to every little change in Pops) that is telling me he is close (guessing perhaps within a month or so) to ESRD something to take seriously or should I just dismiss it?
What will be the first symptoms of ESRD I will most likely notice first?
Once he enters ESRD he will live anywhere from 12 - 48 hours to possibly 12 - 14 days, correct?
Is it true that if his ua specific gravity remains as 1.010, he will be close to, or in ESRD?
Will his urine be "tea-colored" or could it also be absolutely clear? Either of the two?
Is it possible for him to have a lot of red blood cells in his urine without it turning pink or red/brown?
Will he have a high urine output or no urine output at all? Either of the two?
Are the symptoms of ESRD from Hydronephrosis different than from other ESRD?
Here are his renal blood lab results from 11/16/13 and 01/16/14:
11/16/13
BUN – 86
Creatinine –over 3
Potassium – normal
Calcium – a little low
Glucose –
01/16/14
BUN – 28.5
Creatinine – 1.80
Potassium – 4.7
Calcium – 8.1
Glucose – 115
GFR – 37.5
Sodium – 140
Chloride – 106
I have familiarized myself with what dying from ESRD will be like and all the measures that can be taken to ensure a "good" death.
So sorry to be such a neurotic mess!
XXXXXXX
I know I am a real neurotic and a pain in the butt about this!
Papi has chosen to have no extraordinary care...in others words, no dialysis.
By the way, I think I told you his GFR when first diagnosed was 15, but I believe it was actually 20, then after treatment went to 37.5. When he was diagnosed and before my father himself brought up the possibility of having Hydronephrosis and a catheter was placed, his doc told us to be prepared for him to live between several weeks and two months.
I know you cannot predict the future, but ***I am hoping you can give me a *more clear prognosis* in terms of *realistic* time left***. I love Papi very much AND I think I am prepared for his death as much as I can be. Having a better idea of when ESRD might begin would ease my anxiety. Obviously I am depressed, sad, and anxious, but I am enjoying the remaining time I have with Papi. Obviously watching him deteriorate is very distressing.
Papi has become more subdued and tired, and doesn't speak often. He still wishes to go on living. He closes his eyes at the dinner table while he waits for his dinner to be served or most any time when he is not watching TV or reading the newspaper. He seems very fatigued, but not yet *quite* as sleepy and fatigued as he was when his GFR was at 20 or so. He sleeps for approximately 17 hours a day, but has done that for several years, probably due in part to central apnea. He is extremely weak...is able to sit up in bed on his own by pulling himself up with a grip bar, but is unable to raise his feet and legs into the bed. Because it makes him happy, I "walk" him (support him and guide him) from his bed to his easy chair, and he seems to have lost strength in the past week or two weeks. If I had to compare what he seemed like now to how he seemed at the time of diagnosis, I would say he is *almost* back to the same physical and mental state.
What would help me most right now would to have as *realistic* an idea as possible of what to expect in the future. After having been with Papi for six years, and having observed him and changes in him very, very closely for so long (and having seen symptoms building up prior to his diagnosis of RD), I have a pretty good sense that ESRD may begin within the next month or so. I continue to make mental notes of what may seem to be very insignificant changes, but when all put together, they seem significant.
Is there something besides a ua test strip I can use to have a better idea how far along he is in terms of renal disease? Perhaps Rapid Response Micro albumin / Creatinine Urinalysis Reagent Test Strips? I know they are not perfect, but *anything* to help me understand where he is on the renal disease continuum would be better for me than nothing. It is so hard to be with Papi 8 hours a day and slowly watch him deteriorate and wonder how long he will go on this way.
I certainly would not expect you to know for sure or say with any certainty when ESRD might begin since you have not examined him, don't know his medications, etc.
By the way, he takes:
Zoloft 50 mg 1/AM
Flomax 0.4 mg 1/Daily
Metoprolol (spelling?) 50 mg/AM
Lisinipril (spelling?) 5 mg/AM
Hydrocodone 5 mg codiene with 325 mg Tylenol 1/PM for what is thought to be arthritis pain (severe) in left foot
Hydolozine (spelling?) 5 mg/AM which just today was increased to 10 mg due to HBP and 10 mg/PM which was increased from 5 mg/PM about 2 - 3 weeks ago due to HBP.
His blood pressure this morning was 199/106 and frequently has been high in the AMs, hence the increase.
Last week his PM blood pressure ranged from 140 - 170 / 60 - 80. Last night it was 107/54.
Since he is in hospice, he does not have blood work done for diagnostic purposes. His physician could, if he wanted to, have blood work done, but sees no need to do this, and also, then Pops would want to know the results, and at this time he seems to need to be in a bit of denial. Since his doctor told me in January of this year that he could live possibly another year, I already know that.
Questions:
Is my intuition (based on being "tuned in" to every little change in Pops) that is telling me he is close (guessing perhaps within a month or so) to ESRD something to take seriously or should I just dismiss it?
What will be the first symptoms of ESRD I will most likely notice first?
Once he enters ESRD he will live anywhere from 12 - 48 hours to possibly 12 - 14 days, correct?
Is it true that if his ua specific gravity remains as 1.010, he will be close to, or in ESRD?
Will his urine be "tea-colored" or could it also be absolutely clear? Either of the two?
Is it possible for him to have a lot of red blood cells in his urine without it turning pink or red/brown?
Will he have a high urine output or no urine output at all? Either of the two?
Are the symptoms of ESRD from Hydronephrosis different than from other ESRD?
Here are his renal blood lab results from 11/16/13 and 01/16/14:
11/16/13
BUN – 86
Creatinine –over 3
Potassium – normal
Calcium – a little low
Glucose –
01/16/14
BUN – 28.5
Creatinine – 1.80
Potassium – 4.7
Calcium – 8.1
Glucose – 115
GFR – 37.5
Sodium – 140
Chloride – 106
I have familiarized myself with what dying from ESRD will be like and all the measures that can be taken to ensure a "good" death.
So sorry to be such a neurotic mess!
XXXXXXX
Oh - I just read your "brief response" - "Yes, I think close". Sorry I didn't read that before...only saw the longer response.
Oh, and what are the *essential* changes in terms of Glucose, Bilirubin, Ketone, Specific Gravity, Blood, pH, Protein (Albumin, Creatinine), Urobilinogen, Nitrite and Leukocytes? In other words, which if these change, if not all of them, and to *what degree*? What levels indicate ESRD?
Rapid Response UA albumin to creatinine ratio test shows microalbuman is 1500. I think Pops is VERY close to ESRD!
Oh, and what are the *essential* changes in terms of Glucose, Bilirubin, Ketone, Specific Gravity, Blood, pH, Protein (Albumin, Creatinine), Urobilinogen, Nitrite and Leukocytes? In other words, which if these change, if not all of them, and to *what degree*? What levels indicate ESRD?
Rapid Response UA albumin to creatinine ratio test shows microalbuman is 1500. I think Pops is VERY close to ESRD!
Brief Answer:
Here are your answers
Detailed Answer:
Hi,
Is my intuition (based on being "tuned in" to every little change in Pops) that is telling me he is close (guessing perhaps within a month or so) to ESRD something to take seriously or should I just dismiss it?
I would say within 3-6 months. Probably not within one month
What will be the first symptoms of ESRD I will most likely notice first?
Usually patients are tired and then confused
Once he enters ESRD he will live anywhere from 12 - 48 hours to possibly 12 - 14 days, correct?
Yes, that range is accurate; can be variable
Is it true that if his ua specific gravity remains as 1.010, he will be close to, or in ESRD?Will his urine be "tea-colored" or could it also be absolutely clear? Either of the two?Is it possible for him to have a lot of red blood cells in his urine without it turning pink or red/brown?Will he have a high urine output or no urine output at all? Either of the two?
When he has ESRD, he will make very little urine. It can be yellow or dark brown. not likely clear. Yes red cells can be there microscopically and not in the color otherwise.
Are the symptoms of ESRD from Hydronephrosis different than from other ESRD?
Yes, hydronephrosis that is chronic has no symptoms actually.
Here are your answers
Detailed Answer:
Hi,
Is my intuition (based on being "tuned in" to every little change in Pops) that is telling me he is close (guessing perhaps within a month or so) to ESRD something to take seriously or should I just dismiss it?
I would say within 3-6 months. Probably not within one month
What will be the first symptoms of ESRD I will most likely notice first?
Usually patients are tired and then confused
Once he enters ESRD he will live anywhere from 12 - 48 hours to possibly 12 - 14 days, correct?
Yes, that range is accurate; can be variable
Is it true that if his ua specific gravity remains as 1.010, he will be close to, or in ESRD?Will his urine be "tea-colored" or could it also be absolutely clear? Either of the two?Is it possible for him to have a lot of red blood cells in his urine without it turning pink or red/brown?Will he have a high urine output or no urine output at all? Either of the two?
When he has ESRD, he will make very little urine. It can be yellow or dark brown. not likely clear. Yes red cells can be there microscopically and not in the color otherwise.
Are the symptoms of ESRD from Hydronephrosis different than from other ESRD?
Yes, hydronephrosis that is chronic has no symptoms actually.
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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