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What Causes Nephropathy?
Question: Does it seem like I could experience kidney failure eventually and what could be causing this problem and are both my kidneys affected or just one?
I had a GFR of 48 then 2 and a half months later it was 47. I had an ultrasound and it showed mild right-sided renal cortical thinning. The right kidney measures 9.3 x 2.8 x 3.9 cm in size. The left kidney measures 8.8 x 4.2 x 4.8 cm in size. I have constant swelling in my leg below my left knee, some ankle and finger swelling at times but it is all minor. I have some issues with my memory and I find myself losing focus often. I am often fatigued but I ignore it for the most part. I do not have diabetes or high blood pressure. I was diagnosed with Graves disease when I experienced thyrotoxicosis and had to be hospitalized for several days several years ago. At that time I did experience a rapid heart beat and took beta blocker pills for a couple of months. I received antithyroid treatment for six months and it was resolved. At that time my blood tests showed no problem with my kidneys but I did have extreme muscle wasting and was very weak for a long time and lost a lot of weight, about 40 pounds in a two month period which brought me down to 123. After 3 years since I gained weight over 200 but am now at 185. I am 5'6". My thyroid panel is fine now. I suffer occasional diarrhea, shortness of breath sometimes, coughing often and difficulty sleeping regularly. I also suffer from stress on a regular basis. I have had a chest CT scan recently and it showed upper benign damage as I was a long term smoker, quit 8 years ago. No cancer has been indicated. It seems like my GFR has declined quite a bit in a 3 year period. My swelling appeared about a year ago. I do try to exercise regularly. I probably average about six hours a week of aerobic and maybe 2 hours a week of strength exercise. I do work a lot as a self employed Realtor. On many days I start at 8 in the morning and do not finish up until 11 in the evening in order to deal with what has to be done. It is rare to have an entire day off. Since I was diagnosed with Graves, I gave up processed foods and have tried to eat as healthy as possible. Since I have learned about this kidney problem, I have been trying to cut back on protein and eat less potassium, phosphorus and sodium. I am confused because the ultrasound stated that my kidneys were a normal size yet they seem a little small compared to the average size that seems to come up. So my primary care physician did not elaborate on my results other than to remind me to limit my protein and decided to refer me to a nephrologist. He also said that it was too bad this is happening to me at such a young age and that completely confused me because I am 55 years old. What is happening to me? I don't even know what is happening. It could be months before I can get in to see a kidney specialist. I have been doing a lot of research trying to figure this out. The primary care physician did indicate that the nephrologist may be able to find a cause and maybe not and discussed other autoimmune disorders such as Lupus and Good Pasture Syndrome as examples. My last creatinine test showed 1.7 and blood and protein in the urine. My urine is clear and bubbly. Oh I also have abnormal cervical cells but tested HPV negative. I have no symptoms that would lead to any cause as of yet or if that has anything at all to do with my kidney problems. When I was in the hospital they gave me a lot of tests and one of the tests showed that I may have had hepatitis B in the past but that there was no sign of the virus presently in the body. I was tested for hep C also and that turned out negative. I also had a full body CT scan. I drank the contrast and threw that up then they gave me another contrast and I passed out at that time and woke up in a hospital bed. I had high liver enzymes from the thyroid storm but it healed. I have also suffered from arthritis and did take ibuprofen regularly at times but not in excess. I generally did not take more than two in a day and I was just hoping to reduce my swelling with it. My arthritis is not an issue anymore. I find it to be very mild now. I stopped taking NSAIDs and all medications and vitamins when I discovered I had renal insufficiency. I was taking some sleeping pills for several months and some xanax for a couple of months after leaving the hospital but discontinued all of that after a short while. I drink alcohol in moderation on an occasional basis and generally do not have more than one drink at a time. I have never been much of a drinker. I do not do any drugs. I am not taking any medications.
I had a GFR of 48 then 2 and a half months later it was 47. I had an ultrasound and it showed mild right-sided renal cortical thinning. The right kidney measures 9.3 x 2.8 x 3.9 cm in size. The left kidney measures 8.8 x 4.2 x 4.8 cm in size. I have constant swelling in my leg below my left knee, some ankle and finger swelling at times but it is all minor. I have some issues with my memory and I find myself losing focus often. I am often fatigued but I ignore it for the most part. I do not have diabetes or high blood pressure. I was diagnosed with Graves disease when I experienced thyrotoxicosis and had to be hospitalized for several days several years ago. At that time I did experience a rapid heart beat and took beta blocker pills for a couple of months. I received antithyroid treatment for six months and it was resolved. At that time my blood tests showed no problem with my kidneys but I did have extreme muscle wasting and was very weak for a long time and lost a lot of weight, about 40 pounds in a two month period which brought me down to 123. After 3 years since I gained weight over 200 but am now at 185. I am 5'6". My thyroid panel is fine now. I suffer occasional diarrhea, shortness of breath sometimes, coughing often and difficulty sleeping regularly. I also suffer from stress on a regular basis. I have had a chest CT scan recently and it showed upper benign damage as I was a long term smoker, quit 8 years ago. No cancer has been indicated. It seems like my GFR has declined quite a bit in a 3 year period. My swelling appeared about a year ago. I do try to exercise regularly. I probably average about six hours a week of aerobic and maybe 2 hours a week of strength exercise. I do work a lot as a self employed Realtor. On many days I start at 8 in the morning and do not finish up until 11 in the evening in order to deal with what has to be done. It is rare to have an entire day off. Since I was diagnosed with Graves, I gave up processed foods and have tried to eat as healthy as possible. Since I have learned about this kidney problem, I have been trying to cut back on protein and eat less potassium, phosphorus and sodium. I am confused because the ultrasound stated that my kidneys were a normal size yet they seem a little small compared to the average size that seems to come up. So my primary care physician did not elaborate on my results other than to remind me to limit my protein and decided to refer me to a nephrologist. He also said that it was too bad this is happening to me at such a young age and that completely confused me because I am 55 years old. What is happening to me? I don't even know what is happening. It could be months before I can get in to see a kidney specialist. I have been doing a lot of research trying to figure this out. The primary care physician did indicate that the nephrologist may be able to find a cause and maybe not and discussed other autoimmune disorders such as Lupus and Good Pasture Syndrome as examples. My last creatinine test showed 1.7 and blood and protein in the urine. My urine is clear and bubbly. Oh I also have abnormal cervical cells but tested HPV negative. I have no symptoms that would lead to any cause as of yet or if that has anything at all to do with my kidney problems. When I was in the hospital they gave me a lot of tests and one of the tests showed that I may have had hepatitis B in the past but that there was no sign of the virus presently in the body. I was tested for hep C also and that turned out negative. I also had a full body CT scan. I drank the contrast and threw that up then they gave me another contrast and I passed out at that time and woke up in a hospital bed. I had high liver enzymes from the thyroid storm but it healed. I have also suffered from arthritis and did take ibuprofen regularly at times but not in excess. I generally did not take more than two in a day and I was just hoping to reduce my swelling with it. My arthritis is not an issue anymore. I find it to be very mild now. I stopped taking NSAIDs and all medications and vitamins when I discovered I had renal insufficiency. I was taking some sleeping pills for several months and some xanax for a couple of months after leaving the hospital but discontinued all of that after a short while. I drink alcohol in moderation on an occasional basis and generally do not have more than one drink at a time. I have never been much of a drinker. I do not do any drugs. I am not taking any medications.
Brief Answer:
Need to find the cause for nephropathy
Detailed Answer:
Hello
Thanks for the query
I have gone through your history in detail, there are two reasons why you could be having renal failure
1. NSAID induced renal failure. Long term NSAID like Ibuprofen can cause renal insufficiency
2. Hepatitis B is known to cause membranous nephropathy, membranous nephropathy causes protein loss in urine which makes it frothy while urinating.
This is how you should go about it
1. Limit your non vegetarian proteins to just once a week. Avoid red meat completely
2. Limit fluid intake to less than 1.2 litres per day. Fluid includes water and all other liquids
3. Follow a low potassium diet
4. At this point I would see your urine routine, measure the protein in urine put you on kidney protective agents like ACE/ARB like Losartan or Telmesartan
5. GFR will progressively decline even in normal individuals with age however the aim of the doctor should be to limit this as much as possible. This can be achieved with diet, exercise and Ace/ARB to control protein loss in urine
What you need at the moment
1. Get your protein quantified. I can come to a better conclusion if you could attach your urine routine
2. Regular follow ups and checking of S creatinine and potassium
3. I also check for calcium, phosphorus and uric acid once in 5 months
4. Please get an appointment with a renal specialist for a kidney biopsy to know the root cause of your problem
I hope I was of help, if you have any further queries please get back to me. There might be a short delay in my reply since we are celebrating diwali in my house but I will get back to you soon.
Regards and Wish you a very happy diwali
Need to find the cause for nephropathy
Detailed Answer:
Hello
Thanks for the query
I have gone through your history in detail, there are two reasons why you could be having renal failure
1. NSAID induced renal failure. Long term NSAID like Ibuprofen can cause renal insufficiency
2. Hepatitis B is known to cause membranous nephropathy, membranous nephropathy causes protein loss in urine which makes it frothy while urinating.
This is how you should go about it
1. Limit your non vegetarian proteins to just once a week. Avoid red meat completely
2. Limit fluid intake to less than 1.2 litres per day. Fluid includes water and all other liquids
3. Follow a low potassium diet
4. At this point I would see your urine routine, measure the protein in urine put you on kidney protective agents like ACE/ARB like Losartan or Telmesartan
5. GFR will progressively decline even in normal individuals with age however the aim of the doctor should be to limit this as much as possible. This can be achieved with diet, exercise and Ace/ARB to control protein loss in urine
What you need at the moment
1. Get your protein quantified. I can come to a better conclusion if you could attach your urine routine
2. Regular follow ups and checking of S creatinine and potassium
3. I also check for calcium, phosphorus and uric acid once in 5 months
4. Please get an appointment with a renal specialist for a kidney biopsy to know the root cause of your problem
I hope I was of help, if you have any further queries please get back to me. There might be a short delay in my reply since we are celebrating diwali in my house but I will get back to you soon.
Regards and Wish you a very happy diwali
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you for your response. It has given me some better information than I had before and it makes some sense. I have cut down on my protein but not even close to the level you have suggested so that is good information, along with the liquid consumption. I did read that Graves can also cause this, which I have those antibodies too so I guess there could be many reasons for it besides the two you mentioned. I do intend to get in to see a kidney specialist as soon as I am able to.
Do you feel that both of my kidneys may be affected?
Do you feel that both of my kidneys may be affected?
Brief Answer:
Graves disease
Detailed Answer:
Hello
Thanks for getting back, it gives me great pleasure to treat patients online who are asking questions in my field of practice ( Nephrology). You can ask me any number of doubts that you have.
Untreated Graves disease can cause renal issues but since you have undergone treatment for it is unlikely to be the cause.
Yes both the kidneys are affected. Any rise in s creatinine indicates renal failure of both the kidneys, there is no doubt about that.
I hope I was of help
Regards
Graves disease
Detailed Answer:
Hello
Thanks for getting back, it gives me great pleasure to treat patients online who are asking questions in my field of practice ( Nephrology). You can ask me any number of doubts that you have.
Untreated Graves disease can cause renal issues but since you have undergone treatment for it is unlikely to be the cause.
Yes both the kidneys are affected. Any rise in s creatinine indicates renal failure of both the kidneys, there is no doubt about that.
I hope I was of help
Regards
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I have an appointment with a nephrologist on November 11 so hopefully I will have some further knowledge in due time about my condition.
The things I wonder about now are whether this condition is reversible, whether it is likely I will eventually need dialysis and if so how much time is likely before I reach end stage. I realize there are many factors and that every person is different but I was wondering that nevertheless as I am sure many in my situation do.
You have been great in helping me understand a lot. Kidney disease seems so complicated and as I try to read and learn what I can it doesn't get me any closer to understanding my prognosis yet. Perhaps I am lucky that I have found out about it at stage 3 and maybe can have some good amount of time left before it gets worse.
The things I wonder about now are whether this condition is reversible, whether it is likely I will eventually need dialysis and if so how much time is likely before I reach end stage. I realize there are many factors and that every person is different but I was wondering that nevertheless as I am sure many in my situation do.
You have been great in helping me understand a lot. Kidney disease seems so complicated and as I try to read and learn what I can it doesn't get me any closer to understanding my prognosis yet. Perhaps I am lucky that I have found out about it at stage 3 and maybe can have some good amount of time left before it gets worse.
Brief Answer:
Follow up
Detailed Answer:
Hello
I will answer all your questions one by one
1. The conditon is considered irreversible and progressive if the serum creatinine remains high for more than 3 months. Check your serum creatinine after three months to see if it has reversed
2. The progressive nature of the kidney failure is highly unpredictable, since you do not have any co morbid conditions like hypertension or diabetes I predict that you will not require dialysis for another 3-4 years atleast. Keep in touch with me after each time you get the serum creatinine done. Placing you on ACE/ARB drugs will prevent fast progression of the renal failure
3. Do not base your situation strictly on GFR, I have many patients do very well for several years with GFR <30. These patients asymptomatic at that stage as well
Regards
Follow up
Detailed Answer:
Hello
I will answer all your questions one by one
1. The conditon is considered irreversible and progressive if the serum creatinine remains high for more than 3 months. Check your serum creatinine after three months to see if it has reversed
2. The progressive nature of the kidney failure is highly unpredictable, since you do not have any co morbid conditions like hypertension or diabetes I predict that you will not require dialysis for another 3-4 years atleast. Keep in touch with me after each time you get the serum creatinine done. Placing you on ACE/ARB drugs will prevent fast progression of the renal failure
3. Do not base your situation strictly on GFR, I have many patients do very well for several years with GFR <30. These patients asymptomatic at that stage as well
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok I have one final question. You said to keep in touch with you after each serum creatinine is done but I do not know how to do that once I close the discussion here.
I was checked 2.5 months later after the 48 GFR and it went to 47. After my primary care physician saw the ultrasound he decided to refer me to a nephrologist. It does not seem likely that has reversed with cortical thinning and kidneys that seem on the smaller end of normal size.
Good to know I have a few good years left. :).
I was checked 2.5 months later after the 48 GFR and it went to 47. After my primary care physician saw the ultrasound he decided to refer me to a nephrologist. It does not seem likely that has reversed with cortical thinning and kidneys that seem on the smaller end of normal size.
Good to know I have a few good years left. :).
Brief Answer:
Follow up
Detailed Answer:
Hello
1.You can stay in touch by asking a question which starts something like 'Hello Dr Rakesh Madhyastha' and then post your question
2. I have told you earlier as well, dont base things on the GFR. We dont take clinical decision based on GFR alone, there are no many other things to keep in mind. GFR reduced in everybody as you can see it is based on age.
3. Cortical thinning cannot be reversed, we can only make sure the progression is slower.
Get back to me with what the Nephrologist has to say.
You have many good years left, first of all you are not yet in end stage kidney disease, secondly even people with End stage kidney failure live on either on dialysis or after transplant
Regards
Follow up
Detailed Answer:
Hello
1.You can stay in touch by asking a question which starts something like 'Hello Dr Rakesh Madhyastha' and then post your question
2. I have told you earlier as well, dont base things on the GFR. We dont take clinical decision based on GFR alone, there are no many other things to keep in mind. GFR reduced in everybody as you can see it is based on age.
3. Cortical thinning cannot be reversed, we can only make sure the progression is slower.
Get back to me with what the Nephrologist has to say.
You have many good years left, first of all you are not yet in end stage kidney disease, secondly even people with End stage kidney failure live on either on dialysis or after transplant
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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