What Do These Following Lab Reports Indicate?

Posted on Fri, 17 Mar 2017

Question: Hello Doctor,
My father's age is 59 years & he has been suffering with Diabetes for last 15 years.
He is also suffering from High BP & Thyroid from last 6 years.
Recently he had undergone some tests & some issues with his Kidneys were also diagonsed.
I have attached the latest prescription & all the test reports.
For last 1 month, he has been absolutely regular with the medicines prescribed & he is also taking a salt & sugar restricted diet.
He was initially prescribed Calcigard R 20mg tablet thrice a day for his BP which was replaced by Minipress XL 2.5 mg thrice a day after having swelling in his legs.
He is currently taking Minipress just twice a day as he feels a lot of dizziness after taking this medicine & also his BP keeps fluctuating between 120 & 170.
But as per our observation it was a little better with Calcigard & used to be between 130 & 150.
Today he had a lot of vomittings & BP came around 210.
I have few questions now :
1. Why his BP keeps on fluctuating even though he is taking all his medicines religiously & following a proper diet as well ?
2. Can we replace Minipress again with Calcigard tablet ? What exactly is the difference between the two tablets
3. What else he should be doing to keep his BP & Diabetes in control ?
4. What is reason for vomitting & nausea that he feels quite often ?
Please let me know if any other details are required from my end.

Thanks

Answered by Dr. Dr. Abhay A Mali (49 minutes later)

Brief Answer:
May suggest to consult nephrologist.

Detailed Answer:
Hi,

Thanks for your question.

Went through your father's test results.
Elevated serum creatinine , presence of proteins and granular casts in urine all denote possibility of nephropathy (kidney problem- which may be due to diabetes, high blood pressure or changes in small ad major blood vessels of kidney).
Simple urine infection as in your father's case (urine culture grown bacteria) can also lead to kidney problem.

Answers to your Question no 1 & 4 are explained by possibility of nephropathy.
High blood pressure can lead to kidney injury and kidney injury due to other causes may lead to high blood pressure which is difficult to control even with multiple medicines.
Though other causes of resistant blood pressure should also be considered like hormone related.
Due to kidney injury by any cause kidney cannot remove toxic substances (which can not be measured always) from body these substances may lead to vomiting.

Answer to question no 2) Minipress contains Prazosin and Calcigard contains Nifedipine. Both have totally different mechanism of action for controlling blood pressure. Both are safe for kidney. One can be replaced for other or even can safely used together.

Answer to question 2 & 3
I may suggest to consult nephrologist (kidney physician) for detailed history taking and physical examination, depending upon it further evaluation can be planned like Renal doppler (assessment of blood supply of kidney), 24 hours urinary protein or urine albumin creatinine ratio, retinopathy screening, 2D Echo of heart.

Hope this helps.

Regards,
Dr. Abhay Mali.
Diabetologsit.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj