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What Do My Lab Test Reports Indicate?
Question: Hi Doctor,
My mother is 52 years old with CKD. Her creatinine level is 7.14 as per her latest report. Also USG of her whole abdomen shows no trace of right kidney and her left kidney shows complete loss of corticomedullary differentiation with echogenic cortex and medulla. Her left kidney measures 107.9 mm. Urinary bladder is well distended. No mass lesion, calculus or diverticulum is noted in it.
Can you please advice what needs to be done in this case?
Regards,
S. Saha
My mother is 52 years old with CKD. Her creatinine level is 7.14 as per her latest report. Also USG of her whole abdomen shows no trace of right kidney and her left kidney shows complete loss of corticomedullary differentiation with echogenic cortex and medulla. Her left kidney measures 107.9 mm. Urinary bladder is well distended. No mass lesion, calculus or diverticulum is noted in it.
Can you please advice what needs to be done in this case?
Regards,
S. Saha
Brief Answer:
DTPA scan
Detailed Answer:
Hello
Thanks for the query
From the reports you have furnished it looks like your mother is suffering from chronic kidney disease and congenital single kidney. Here is how you should go about it
1. In order to confirm that there is only one kidney you will need to get a dtpa scan done , it is a radioisotope scan which will confirm the absence of a kidney. This will also tell us how well the kidneys are functioning win fair accuracy. If dtpa is not available in your area a plain ct scan of the abdomen can also help with less accuracy than dtpa.
2. loss of corticomedullary differentiation means that the kidney is damaged to a large extent
3. if you can attach hemoglobin, phosphorus , calcium and uric acid reports I can tell you in more detail about what medications needs to be changed or altered apart from the ones she is already on
I am sure you have several doubts, please get back to me with them. Asking specific questions can help me serve you better. For example: what should the diet be, fluid intake , etc.
Regards
DTPA scan
Detailed Answer:
Hello
Thanks for the query
From the reports you have furnished it looks like your mother is suffering from chronic kidney disease and congenital single kidney. Here is how you should go about it
1. In order to confirm that there is only one kidney you will need to get a dtpa scan done , it is a radioisotope scan which will confirm the absence of a kidney. This will also tell us how well the kidneys are functioning win fair accuracy. If dtpa is not available in your area a plain ct scan of the abdomen can also help with less accuracy than dtpa.
2. loss of corticomedullary differentiation means that the kidney is damaged to a large extent
3. if you can attach hemoglobin, phosphorus , calcium and uric acid reports I can tell you in more detail about what medications needs to be changed or altered apart from the ones she is already on
I am sure you have several doubts, please get back to me with them. Asking specific questions can help me serve you better. For example: what should the diet be, fluid intake , etc.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
hello Doctor,
Thanks for your reply.
Though her latest USG report shows no trace of right kidney but her USG done on 2012 stated the following :
Right Kidney : It is small in size - looks hyperechoic with significant loss of corticomedullary differentiation. No calculus or obstructive changes seen. Right kidney measures 82mm.
Left Kidney : It is normal in size and shape. Renal parenchyma is mildly hyperechoic with mild loss of cortico-medullary differentiation. No calculus or obstructive changes seen. LK measures 111mm.
Is it possible for a kidney to vanish within this 4 years time? If so, why did this happen?
Also her uric acid count is 4.40 mg/DL done on 05.12.2015.
I have attached report copies of HB, phosphorous, calcium, prescription, USG report for your reference. Her diet consists of 2 chapattis and a bowl of vegetables such as beet, carrot, gourd, a bit of potato, onion cooked in minimal oil at about 10.30 in the morning, at around 12.30 she have a pear or cucumber, she takes her lunch at 2.30 which consists of a small bowl of rice, a bowl of vegetables as mentioned and 50g of fish(alternate days), at about 6.30 in the evening she takes a cup of tea without sugar and two XXXXXXX biscuits. At about 10.30 she have her dinner with 2 chapattis and a bowl of veggies. Her total fluid intake throughout the day is 1.5lt. Us her diet all right or she needs a change on that? Also does she needs dialysis at this stage?
Kindly advise.
Regards,
S.Saha
Thanks for your reply.
Though her latest USG report shows no trace of right kidney but her USG done on 2012 stated the following :
Right Kidney : It is small in size - looks hyperechoic with significant loss of corticomedullary differentiation. No calculus or obstructive changes seen. Right kidney measures 82mm.
Left Kidney : It is normal in size and shape. Renal parenchyma is mildly hyperechoic with mild loss of cortico-medullary differentiation. No calculus or obstructive changes seen. LK measures 111mm.
Is it possible for a kidney to vanish within this 4 years time? If so, why did this happen?
Also her uric acid count is 4.40 mg/DL done on 05.12.2015.
I have attached report copies of HB, phosphorous, calcium, prescription, USG report for your reference. Her diet consists of 2 chapattis and a bowl of vegetables such as beet, carrot, gourd, a bit of potato, onion cooked in minimal oil at about 10.30 in the morning, at around 12.30 she have a pear or cucumber, she takes her lunch at 2.30 which consists of a small bowl of rice, a bowl of vegetables as mentioned and 50g of fish(alternate days), at about 6.30 in the evening she takes a cup of tea without sugar and two XXXXXXX biscuits. At about 10.30 she have her dinner with 2 chapattis and a bowl of veggies. Her total fluid intake throughout the day is 1.5lt. Us her diet all right or she needs a change on that? Also does she needs dialysis at this stage?
Kindly advise.
Regards,
S.Saha
Brief Answer:
Chronic kidney disease
Detailed Answer:
Hello
Thanks for getting back
I shall answer your questions one by one so that I dont miss any
1. It is not possible for a kidney to just vanish. However it can shrink in size significantly. It is due to loss of nephrons.
2. Her uric acid is within normal limits. Let her continue with Tab Febuget
3. Her lab parameters are within acceptable limits. The only that requires further correction is phosphorus. Make sure that she is taking Tab Phoscut along with meals. For example, Let her eat 1 chapathi, swallow phoscut and then continue to eat. Cutting down on green leaft vegetables can further bring phosphorus down
4. Her diet is excellent, let her continue with it. However she will do better by cutting down on green leafy vegetables
5. 1.5 litre of water is very high for someone with a creat of 7 mg/dl. I recommend not more than a litre per day
6. Starting of dialysis is strictly a clinical decision. If she is eating well, does not have swelling of legs or breathlessness then dialysis can be delayed. I suggest you to get a A v fistula done in the mean while. It is a small socket created by connecting artery and veins around the elbow to connect the dialysis needles
I hope I was of help, if you have any further queries please get back to me
Regards
Chronic kidney disease
Detailed Answer:
Hello
Thanks for getting back
I shall answer your questions one by one so that I dont miss any
1. It is not possible for a kidney to just vanish. However it can shrink in size significantly. It is due to loss of nephrons.
2. Her uric acid is within normal limits. Let her continue with Tab Febuget
3. Her lab parameters are within acceptable limits. The only that requires further correction is phosphorus. Make sure that she is taking Tab Phoscut along with meals. For example, Let her eat 1 chapathi, swallow phoscut and then continue to eat. Cutting down on green leaft vegetables can further bring phosphorus down
4. Her diet is excellent, let her continue with it. However she will do better by cutting down on green leafy vegetables
5. 1.5 litre of water is very high for someone with a creat of 7 mg/dl. I recommend not more than a litre per day
6. Starting of dialysis is strictly a clinical decision. If she is eating well, does not have swelling of legs or breathlessness then dialysis can be delayed. I suggest you to get a A v fistula done in the mean while. It is a small socket created by connecting artery and veins around the elbow to connect the dialysis needles
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. Yogesh D
Hi Doctor,
Thanks for reading the questions with patience and replying back.
As of now my mom's creatinine level has shot up to 8.8. the nephrologist checking her has advised for dialysis or kidney replacement. She is a patient of hypertension for past 26 years. Her current blood pressure is 150/80. Blood group is B+.
Since doctor has advised her to get a kidney replacement done, I am planning to be the doner of a kidney. I am a 24 year old female with B+ blood group, hb level 11.9, normal Bp, no Diabetes, no thyroid. In 2009 I had a cystectomy of right ovary along with appendix removal. Ever since I am under complete supervision of gynecologist for poly cystic ovarian syndrome. My question to you is, will it be possible for me to donate one of my kidneys to her so that she survives better? Also what are the post operative complications for both of us? To what extent will her survival chances be increased.
Kindly advise.
Regards.
Thanks for reading the questions with patience and replying back.
As of now my mom's creatinine level has shot up to 8.8. the nephrologist checking her has advised for dialysis or kidney replacement. She is a patient of hypertension for past 26 years. Her current blood pressure is 150/80. Blood group is B+.
Since doctor has advised her to get a kidney replacement done, I am planning to be the doner of a kidney. I am a 24 year old female with B+ blood group, hb level 11.9, normal Bp, no Diabetes, no thyroid. In 2009 I had a cystectomy of right ovary along with appendix removal. Ever since I am under complete supervision of gynecologist for poly cystic ovarian syndrome. My question to you is, will it be possible for me to donate one of my kidneys to her so that she survives better? Also what are the post operative complications for both of us? To what extent will her survival chances be increased.
Kindly advise.
Regards.
Brief Answer:
Renal transplantation
Detailed Answer:
Hello
Thanks for getting back
As your mother is young I recommend kidney transplant in her. You can certainly be the donor for her. In fact you can get the kidney transplant done in our hospital
I feel your questions are better answered on one on one basis rather than question and answers way, however I will try my best to answer your questions
1. Yes you can be the donor. If you are married then consent should be taken from your husband to be able to legally donate ( as per our state, please look into your state laws )
2. the survival of a ckd patient is far better with improved quality of life than dialysis patients. The usual survival from a live related kidney transplant is about 15 years, some patients have survived beyond that
3. In a recipient the major complications are infections, development of uncontrolled sugar, weight gain, kidney rejection, etc
4. renal donors usually do well however since you are young there are increased chances of developing hypertension especially during pregnancy
5. pcod is not a contraindication for renal transplant
I am sure you will have more doubts, please get back to me if you need any further clarifications
Regards
Renal transplantation
Detailed Answer:
Hello
Thanks for getting back
As your mother is young I recommend kidney transplant in her. You can certainly be the donor for her. In fact you can get the kidney transplant done in our hospital
I feel your questions are better answered on one on one basis rather than question and answers way, however I will try my best to answer your questions
1. Yes you can be the donor. If you are married then consent should be taken from your husband to be able to legally donate ( as per our state, please look into your state laws )
2. the survival of a ckd patient is far better with improved quality of life than dialysis patients. The usual survival from a live related kidney transplant is about 15 years, some patients have survived beyond that
3. In a recipient the major complications are infections, development of uncontrolled sugar, weight gain, kidney rejection, etc
4. renal donors usually do well however since you are young there are increased chances of developing hypertension especially during pregnancy
5. pcod is not a contraindication for renal transplant
I am sure you will have more doubts, please get back to me if you need any further clarifications
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello Doctor,
Thanks for replying again.
I am unmarried. But my mom and dad are bit skeptical about me donating my kidney. Still I am trying to make them understand that a person can get along well by only a kidney.In the meanwhile, our nephrologist have advised my mother to get an AV fistula done. However she do not suffer from any kind of swelling on leg or breathlessness. Even she doesnot have problem in urinating. She urinates in normal volume based on her fluid intake which I have cut short to 1 lt based on your recommendation. But now a days she complains me about vomiting. Also she develops some cough in the morning. I have rechecked her serum urea count. Her latest report showed 166 mg/100ml which is pretty high. I want to ask whether this is creating a vomiting tendency because of urea deposition.Also if her kidneys are damaged, how can she urinate properly? Is there any chances of her urine to get obstructed? She is not having any kind of urinary tract infection. Her nephrologist have recommended her to take dialysis thrice a week after her AV fistula matures. Will she feel weak post each dialysis? Do I need to give her high protein food after her dialysis starts to make her physically strong since high protein diet is completely restricted now? Also can her body resist 3 dialysis a week?
Now for kidney transplant, my question is can a patie.nt opt for her kidney replacement during her dialysis period? Will this be as effective as opting for replacement before dialysis? Also I have read that post operation doctors subject the recipient to severe immunosuppressant drugs which have many side effects. How do we need to handle these? Lastly I would like to have your email id and Hosp details to which you are attached so that I can be in touch with you. Thank you once again. Regards.
Thanks for replying again.
I am unmarried. But my mom and dad are bit skeptical about me donating my kidney. Still I am trying to make them understand that a person can get along well by only a kidney.In the meanwhile, our nephrologist have advised my mother to get an AV fistula done. However she do not suffer from any kind of swelling on leg or breathlessness. Even she doesnot have problem in urinating. She urinates in normal volume based on her fluid intake which I have cut short to 1 lt based on your recommendation. But now a days she complains me about vomiting. Also she develops some cough in the morning. I have rechecked her serum urea count. Her latest report showed 166 mg/100ml which is pretty high. I want to ask whether this is creating a vomiting tendency because of urea deposition.Also if her kidneys are damaged, how can she urinate properly? Is there any chances of her urine to get obstructed? She is not having any kind of urinary tract infection. Her nephrologist have recommended her to take dialysis thrice a week after her AV fistula matures. Will she feel weak post each dialysis? Do I need to give her high protein food after her dialysis starts to make her physically strong since high protein diet is completely restricted now? Also can her body resist 3 dialysis a week?
Now for kidney transplant, my question is can a patie.nt opt for her kidney replacement during her dialysis period? Will this be as effective as opting for replacement before dialysis? Also I have read that post operation doctors subject the recipient to severe immunosuppressant drugs which have many side effects. How do we need to handle these? Lastly I would like to have your email id and Hosp details to which you are attached so that I can be in touch with you. Thank you once again. Regards.
Brief Answer:
Dialysis
Detailed Answer:
hello
Thanks for getting back. Since there are several questions I will try and answer them one by one so that I don't miss any.
1. Since she has loss of appetite and vomiting with creat of 8, I recommend initiation of dialysis. Further delay will only compromise her XXXXXXX further
2. dialysis will make her weak for a few hours post dialysis but she will be better from then on. Her appetite will improve and so will the quality of life
3. she is able to pass urine but the urine has not been filtered appropriately for all the toxins. Normal amount of urine is usually seen in patients with chronic interstitial nephritis
4. yes, transplant can be done once she is on dialysis. Pre emptive transplant would have been a better option however your mother needs dialysis at the moment so she cannot be transplanted without dialysis
5. immunisupression is handled by specialist like us who are familiar with it. Patients usually do well and we reduce immunisupression after 6 months to minimum requirement
I hope I was clear, my hospital details is in my profile.
Regards
Dialysis
Detailed Answer:
hello
Thanks for getting back. Since there are several questions I will try and answer them one by one so that I don't miss any.
1. Since she has loss of appetite and vomiting with creat of 8, I recommend initiation of dialysis. Further delay will only compromise her XXXXXXX further
2. dialysis will make her weak for a few hours post dialysis but she will be better from then on. Her appetite will improve and so will the quality of life
3. she is able to pass urine but the urine has not been filtered appropriately for all the toxins. Normal amount of urine is usually seen in patients with chronic interstitial nephritis
4. yes, transplant can be done once she is on dialysis. Pre emptive transplant would have been a better option however your mother needs dialysis at the moment so she cannot be transplanted without dialysis
5. immunisupression is handled by specialist like us who are familiar with it. Patients usually do well and we reduce immunisupression after 6 months to minimum requirement
I hope I was clear, my hospital details is in my profile.
Regards
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Above answer was peer-reviewed by :
Dr. Yogesh D
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