Bad News: Renal insufficiency

bella3

VascodaGama said:

My appointment with a Nephrologist

You were all correct; I have CKD (chronic kidney disease) stage 3 with no chances for a fix. According to the nephrologist, I should now care to avoid further deterioration. He went through all the results and image study reports since 2010 and said that I should have done something starting in the fall of 2014. At that time I may had a case of acute kidney injury, which usually is reversible.

In regards to the long cysts (7.6 and 6.7 cm) in left kidney he commented these not being the problem. He doesn't recommend draining because these will refill again in a short period of time. "...Your problem is aging (Denistd was right), cysts are common in older people ...".
The Creatinine in urine at 24 hours and its clearance are the most important markers. My lastest (Sep/2016) was still good at 90 mL/minute, with a creatinine of 132 mg/dl (in blood was 1.61 mg/dl). He thinks my numbers to be out of the best parameters  but not ridiculous worse. The Ionogramme was balanced with sodium at 143, potassium at 4.6 and chloride at 105. Suggested for me to lower salt content in diets and recommended me to change the present BP (blood pressure) medication to Co-Diovan 80/12.5 mg taken at breakfast plus Lercanidipine 20 at dinner (this is also a calcium channel blocker similar to Adalat but works differently). He believes that the high blood pressure is the cause behind a series of symptoms I have been experiencing since summer of 2016. The CKD may be causing me urinary frequency when sleeping (4 to 5 times waking up to urinate). My next consultation is for April 2017 with more fasting blood and urine tests and with the results of the newer daily CCBs.

Regarding the 68Ga PSMA PET he said that he is not aware of the radioisotope details but commented that they care for CKD inpatients doing MRI with contrast, followed straight by dialysis. He suggested to inquire at big hospitals where I can become an inpatient to do the PET and dialysis in a set.

Well, I need to look into a fitness program and better diet. Meanwhile I will try consulting an urologist for a second opinion. 

Thanks to all of you for the suggestions and recommendations.

VGama

He suggested to inquire at

He suggested to inquire at big hospitals where I can become an inpatient to do the PET and dialysis in a set.

 

....This advice is terrifying to me.  Dialysis for stage 3 is crazy. Dialysis is not to be taken lightly. Perhaps a second opinion with a different nephrologis.  I don't know much about the PET you seek but think hard before agreeing to contrast. Short on time here but had to chime in.

VascodaGama

No dialysis but good news

Bella,

I read your cautious note above. Thank you. I wouldn’t follow the procedure unless I become desperate. It seems that they do dialysis after a MRI exam with contrast in extreme cases. In any case, I do not want to miss an important image exam in my PCa case, for the sake of CKD. When time comes, either, I find a place that accept patients with low levels of clearance (eGFR) or chose something more drastic.

Mean while I have good news. This is two weeks since I started the newer pills for blood pressure and have changed some items in my diet. I have not forced any drastic regimen in my daily routines or diet but can feel some difference already. So far, BP numbers have decreased to a median 132/85, from 155/100, and now I tie my belt one inch shorter.

As commented in previous posts, I intend to follow a regimen with defined procedures and established goals but I am still researching for a model. The regimen will be practical not just for the kidney issues but the “fatty liver” condition that has been identified years ago. Some foods are better for the liver but do not as well for the kidneys. I am looking for means to adapt my traditional Mediterranean (Portuguese) diet, giving preferences to certain elements. I plan also to intercalate sometimes, Japanese meals (my second homeland) that include a variety of seaweeds and different vegetables (not traditional) which seem to be recommendable in kidney problems.

At the moment I have cut in salt, prepare meals at home, stop eating white bread and pastries, and have shorten the portions I eat by 1/5 approximately. Meals are mainly boiled mixed vegetables (in soup or alfresco with fish or chicken). Have not touched in meat and instead of salt I season the food with ground pepper or unsalted soy sauce. I accompany the meals with whole grain bread, a piece of cottage cheese and red wine, and fruits to complete the meal.  I still walk 5Km daily.

These simple changes are paying its dividends. The evident results in just two weeks could be due to a better efficacy of the newer drugs and for stopping the white bread.

Best wishes to all.

VGama

bella3

VascodaGama said:

No dialysis but good news

Bella,

I read your cautious note above. Thank you. I wouldn’t follow the procedure unless I become desperate. It seems that they do dialysis after a MRI exam with contrast in extreme cases. In any case, I do not want to miss an important image exam in my PCa case, for the sake of CKD. When time comes, either, I find a place that accept patients with low levels of clearance (eGFR) or chose something more drastic.

Mean while I have good news. This is two weeks since I started the newer pills for blood pressure and have changed some items in my diet. I have not forced any drastic regimen in my daily routines or diet but can feel some difference already. So far, BP numbers have decreased to a median 132/85, from 155/100, and now I tie my belt one inch shorter.

As commented in previous posts, I intend to follow a regimen with defined procedures and established goals but I am still researching for a model. The regimen will be practical not just for the kidney issues but the “fatty liver” condition that has been identified years ago. Some foods are better for the liver but do not as well for the kidneys. I am looking for means to adapt my traditional Mediterranean (Portuguese) diet, giving preferences to certain elements. I plan also to intercalate sometimes, Japanese meals (my second homeland) that include a variety of seaweeds and different vegetables (not traditional) which seem to be recommendable in kidney problems.

At the moment I have cut in salt, prepare meals at home, stop eating white bread and pastries, and have shorten the portions I eat by 1/5 approximately. Meals are mainly boiled mixed vegetables (in soup or alfresco with fish or chicken). Have not touched in meat and instead of salt I season the food with ground pepper or unsalted soy sauce. I accompany the meals with whole grain bread, a piece of cottage cheese and red wine, and fruits to complete the meal.  I still walk 5Km daily.

These simple changes are paying its dividends. The evident results in just two weeks could be due to a better efficacy of the newer drugs and for stopping the white bread.

Best wishes to all.

VGama

Wow, fabulous progress! Your

Wow, fabulous progress! Your motivation and willpower are enviable.  I didn't intend to come off as harsh earlier.  It's just that everything dad and I do revolves around avoiding dialysis.  It is still the priority, even now with his advanced metastatic prostate cancer to deal with.

Best wishes.

tarhoosier

The best patient

VdaG:

An educated patient is the very best patient, as you yourself demonstrate. In many cases the other conditions for an individual become as important as psa or residual tumor. I am just looking in here after a long absence. I am still well. Charles Myers still cares for me in his special way. To Vasco:  Boa sorte.

Gleason Score 9 and 10

VascodaGama said:

No dialysis but good news

Bella,

I read your cautious note above. Thank you. I wouldn’t follow the procedure unless I become desperate. It seems that they do dialysis after a MRI exam with contrast in extreme cases. In any case, I do not want to miss an important image exam in my PCa case, for the sake of CKD. When time comes, either, I find a place that accept patients with low levels of clearance (eGFR) or chose something more drastic.

Mean while I have good news. This is two weeks since I started the newer pills for blood pressure and have changed some items in my diet. I have not forced any drastic regimen in my daily routines or diet but can feel some difference already. So far, BP numbers have decreased to a median 132/85, from 155/100, and now I tie my belt one inch shorter.

As commented in previous posts, I intend to follow a regimen with defined procedures and established goals but I am still researching for a model. The regimen will be practical not just for the kidney issues but the “fatty liver” condition that has been identified years ago. Some foods are better for the liver but do not as well for the kidneys. I am looking for means to adapt my traditional Mediterranean (Portuguese) diet, giving preferences to certain elements. I plan also to intercalate sometimes, Japanese meals (my second homeland) that include a variety of seaweeds and different vegetables (not traditional) which seem to be recommendable in kidney problems.

At the moment I have cut in salt, prepare meals at home, stop eating white bread and pastries, and have shorten the portions I eat by 1/5 approximately. Meals are mainly boiled mixed vegetables (in soup or alfresco with fish or chicken). Have not touched in meat and instead of salt I season the food with ground pepper or unsalted soy sauce. I accompany the meals with whole grain bread, a piece of cottage cheese and red wine, and fruits to complete the meal.  I still walk 5Km daily.

These simple changes are paying its dividends. The evident results in just two weeks could be due to a better efficacy of the newer drugs and for stopping the white bread.

Best wishes to all.

VGama

Simple Changes

VGama,

What wonderful news...not only in the change of numbers you have seen, but I might well guess, in how you feel! Taking care of our bodies is paramount, and in just two short weeks you have shared how extraordinary the benefits can be! 

I hope to hear this has continued! Keep up the good work, and with equal importance, continue to inspire the rest of us with your knowledge and education of your case and others!

Cheers to you!

Janice

VascodaGama

All markers on CKD issue are worse. A gloomy moment of my case

I just got my blood and urine exams but these show a worse condition in spite of the efforts done along the 2.5 months with restrictive diet, medication and change in life style. The nephrologist is not worried and commented to be expecting an increased creatinine. He reserved my next consultation for September.

I feel desolated because I was expecting improvements that would permit me to continue my wish for the 68Ga PSMA PET scan. In fact I feel healthier, have lost weight (approximately 17 pounds) and got more energy. The Michelin tire around my waist is now flattened and disfigured. I can tie my belt two holes lesser thought it seems that I need to do something more drastic. I may need to cut more in fish and cheese in my Mediterranean diet and soy products like soy-sauce in my Japanese diet. Walking 5 KM daily is OK but cannot involve strength exercises to build muscle (the source of creatinine).

The nephrologist commented that salt is the worst thing for my situation. He said that I can eat meat in moderation (about 150 grams in 5 days), but I am limiting the intake to poultry. Also I give preferences to low potassium veggies and legumes. My blood sugar has decreased (96 mg/dL) representing a signal of a more balanced diet and less provable of diabetes.

The creatinine has increased about 10%, now at 1.84 mg/dL, and the GFRe is worse at 39.2, but the concentration of albumin in blood has increased ruling out a bad metabolism in liver, which could be related to my change in diet. The clearance rate in 24 hours was lower at 70 mL/min. This is the marker used by the nephrologist to judge my condition. He commented that dialysis (kidney failure) is required when this marker gets lower than 30 mL/min. The lower limit in clearance of a 70 years old patient is 50 mL/min. Best is 130. The Urea in blood (uremia) also increased to 52 mg/dL.

According to the nephrologist, all these markers indicating a worse outcome in my kidneys function (less filtration and more waste products in blood) are a cause of the Co-Diovan 80/12.5. He commented that this blood pressure medication (angiotensin-converting enzyme inhibitor and diuretic) typically increases the creatinine in blood to about 20%. The volume of filtration is reduced but the lower blood pressure protects the kidneys in the long run because it lowers the need for increased function.

In short words, the present test results under the Co-Diovan effect cannot be used for comparison with the previous results (no medication effects) for judging a worse scenario. I will need to continue my efforts and test again in four months to real have the info that will serve to verify if I am doing it well in the control of my chronic kidney disease.

Aside from the above, the PSA also increased from the plateau at 1.5 to 1.81 ng/ml. It accompanied the increase of my endogenous testosterone from 262 to 377 ng/dL. I am now closer to the 2.0 threshold for restarting HT and should be looking for a clinic that will allow me doing the PSMA PET exam.

Can I really do it?

Best to all,

VGama

Old Salt

Too pessimistic?

I see a lot of good news in your message:

Your nephrologist is not worried

You are feeling healthier and have lost weight

You feel more energetic

Hopefully the (creatinine etc) numbers will be better by September, your next doctor's visit.

Just stick with your new program in the meantime.