CSN Login
Members Online: 9

You are here

Bad News: Renal insufficiency

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

Many guys reading my PCa story with the many ups and downs occurrences and continuing journey, and probably thinking to follow a similar path need to be alarmed of the consequences that a renal insufficiency can bring into their PCa case. The last PSA test confirmed a sort of cancer hibernation verified by a sluggish action with a plateau level of 1.5 since March of 2015. You can read details on my thread in here.
 
The above situation let me enjoy a period off drugs and therefore a continued period off treatment symptoms. However, yesterday I called a radiologist in charge of PET scans (at Coimbra hospital) to inquire about their creatinine levels and was told that I cannot have the 68ga PSMA PET exam if I have renal insufficiency, even if it is a slight condition.

It all started from my last blood tests confirming an increase in some markers that verify liver and kidneys functions. The creatinine come at 1.65 ng/dL (it has reached 1.77 in 2015) high above the normal of 1.20. The Microalbuminuria at 45.1 (24H) and Glomerular filtration rate (GFR) 44.5 also have maintain levels away from the normal making me to believe that I am pre-diabetes. The indicators AST, ALT and GGT are within the normal parameters but ALP has decreased (alarm on enzymes proliferation).

My GP sent me for a CT to sort out things on the markers for latter exam by an urologist, but the radiologist at the nuclear facilities did the exam without contrast (no proper means for comparison) impairing the diagnosis of the kidney. He told me that all image exams (CT, MRI, etc) in my case cannot use any type of contrast agent because the markers indicate renal insufficiency. The maximum value in creatinine used at their facilities is 1.35 ng/dL. The issue brought me red flags and made me to call Coimbra as commented above.
The facts are a big blow into my wish for a PCa oligometastatic treatment. I hope this post alarms the many reading it so that they can proceed with cautionary measures.

Surely, the bandit is allowing me time to try regulating the renal issue but can I do it so easily? I need to consult an expert on kidney insufficiency. It may involve doctors from different specialties. I wonder if one of my comrades here had such an experience and can help me to understand things on the problem. Any opinion would be appreciated.

Thanks in advance.

VGama

Will Doran
Posts: 207
Joined: Sep 2015

VG,

Are you on a high protein diet?  Or are you dehydrated?   Just asking.  I ran into this once, years back.  I got to the hospital and my numbers were all messed up.  My ketones were way off and then they realized that I was dehydrated because I had been off food and water for a good part of the day, and after coming back from a long road bicycle ride.  So, as they were running tests, my tests were all messed up..  My kindey function was also messed up.  They ask if I was on a high protein diet.  They said that can mess up the kidney function readings as well.  As we all say, we are not doctors, but, you may want to check  what these things can do to those numbers.  I'm just speaking from what I ran into back a good number of years, way before I was dealing with this cancer.  They put me on IV fluids and got things back in order.

Just a thought.

Will

xNTP
Posts: 34
Joined: Oct 2016

My first question is how far have you optimized the protein load, the ketogenic - low carb diet and hydration parts ?  

I had foam problems years and years ago, with many things going on.   Partly I cut back on huge carbs and protein loads, and then solved other problems,  For a while I was fastidious about diet and supplements.   Some that were of particular interest were riboflavin (the kidney is supposed to be the riboflavin richest organ) and P5P or pyridoxamine (see LEF stories).   Perhap as others too,  including magnesium, NAC, coQ10, ALA and silimarin

I think you've referred to some of the LEF stuff before.  What about this article?   At one stretch I felt the most  pronounced  kidney sign(s) from aggressive riboflavin use, but I had also earlier experienced chelitis, a classic sign of gross deficiency.    THe LEF stuff has been useful to us a number of times, including most of the items in that article.

 

bella3
Posts: 25
Joined: Jan 2017

I'm sorry to hear as you are so generous in helping so many.  We are new to PC but dad, 83, has lived with very low kidney function (9% currently) for years with no dialysis in sight.  Docs are surprised as he also has few if any symptoms.  I believe that is due to his great compliance with diet, exercise and supplements that we have reaseserched and slowly added over the years. (Everything though is first run by his nephrolgist) .  

At a glance...small portions of protein in form of organic chicken, eggs salmon, abundant healthy kidney safe fruit and veggies..cabbage, cauliflower, red peppers. Others depend on your current potassium and phosphorus levels.  ALOT of pure water each day, often with a little fresh lemon or apple cider vinegar. No red meat, pork, alcohol, minimal dairy.

Monitor blood pressure and blood sugar as high levels can harm kidnay function.  At 44 gfr yours are still quite healthy and short of a diagnosed disease (dad had a kidney removed due to benign tumor but also high blood and diabetes,  I believe you can improve it the relatively short way to a normal 60 gfr.

it would be helpful to see a nephrologist who has experience with PC patients.  Ours has many but apparently dad is only with bone metastasis.

Prayers and best to you.

denistd's picture
denistd
Posts: 596
Joined: Apr 2009

Hi Vasco, I had chemo in 2009 (cisplatin) this did some damage to my kidneys, I have had this situation since then, my creatinine bounces up and dpwn, all depends on how hydrated you are and other factors, hydration being the most important. I have been as kow as 1.34 and as high as 1.93. You definitely cannot have contrast and stay away from Nsaid pain relievers. Renal insufficiency is a very common development in older people, NIH says there are about 28,000,000 Americans with the disease, mostly stage 3 which you and I are and most don't know it, just keep an eye on it, but find out what exactly caused it. You should also have your BUN checked, mine is normal. It is called CKD, but that means two different situations, chronic kidney disease and chronic kidney damage. Denis

 

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

Vasco, much of your post is over my head, but I do understand "prediabetic."  Often prediabetic also means overweight.  I have read that the Keto diet may be helpful to you.  Here is the least biased thread I could find: http://www.everydayhealth.com/type-2-diabetes/diet/keto-diet-diabetes/

I really cannot comment on whether this diet is good for all.  Body builders do it because ALL the fat disappears and guys get really ripped.  I have been it for a month.  I weigh the same, but the fat is really dripping off.  I can see changes in my abs on an almost daily basis.  That said, the diet sucks as a life style choice, unless you enjoy sitting down to a dinner of butter, cocoanut oil, cream heated in either coffee or a bullion cube. Mmmmmmmmm, Mmmmmmmmmmmm!!! Man is THAT good eatin'.  Love, Swami Rakendra

denistd's picture
denistd
Posts: 596
Joined: Apr 2009

Also on the pre-diabetes front, my fasting glucose levels show that I am pre-diabetic too, my last fasting test was 109, max normal is 99. The biggest contributor to this problem are carbs, when this showed up a few years ago I was told to stay away from "white foods" white bread, potatoes, rice, noodles and of course keep the sugar intake down. DEnis

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

I want to thank all of you for the opinions. They are precious to me. Your suggestion on the causes in the increasing numbers points to dehydration and poor diet. This is something I can fault myself for getting loose since the end of HT. The side effects were gone so I stop the cautionary measures I was taking for prevention. I do not play golf or walk as much as I used to do and now I eat more in restaurants than at home. My diet incorporates more bread, potatoes and rice, and lesser amounts of veggies. Probably it has more salt too. I still give preferences to fish but they usually are grilled (is it bad?). In regards to drinks, no spirits but about 3 liters of water daily and red wine with meals. I eat seasonal fruits all day long. I have now a Michelin tire (still bicycle size) around my waist.

It seems that I can handle it back to a better diet and gym work, however, I wonder if I need something more drastic to put me back into the rails. My understanding on Kidney insufficiency regards the inability of kidneys in disposing off body waste transported to them by the blood. These trash end up being accumulated at certain parts in the body, including the substances (C11, F18, 68Ga, Gu, Io, etc) used as contrast in image studies (maybe the reason for denying a PET exam). I wonder if by lessening body waste from foods, my kidneys manage to get back to normal function or if the situation got that bad that the kidneys can’t be repaired.

This is all new to me and like prostate cancer before diagnosis I never saw the case as important until now. Talking about specifics, there exist some cysts in my left kidney (monitored annually and considered benign) and one of them has increased from 1.2 cm (in 1976) to 6.8 cm (in 2015). In the ultrasound image we can see a long “thumb-type” protuberance extruding out of the kidney. I wonder if this is pressing something causing the insufficiency. Doctors who have viewed the images never saw it negatively, but it may need to be removed (suction or dissected). The case could be a blockage in the renal artery needing a clean up or stent.
How do they find if the left kidney has stopped working completely?
Can I think that the markers are just slightly out of the normal range and that I may regulate it back in time for the PET scan?
Is an urologist the proper guy to consult firstly?

Will and xNTP; your comments took me to recognize the role of the chemistry in my diet. I sincerely had no clue on it.
Bella; thanks for the suggestion in diet. The Potassium is 4.6 mmol/L  and the Phosphorus  is 2.8 mg/dL. Do you have a suggestion on how I can improve to a normal 60 gfr? I have been controlling blood pressure with Adalat 30 daily and the cholesterol with intermittent periods on Simvastatin 20 mg. I also take aspirin 100mg daily since 2001 recommended by my JH oncologist. These are the solo medication I am taking. The suggestion on nephrologists is great. I did not know about this specialty.
Denistd; you were right; I did not know that I am CKD stage 3. I looked back into the tests since 2008 (before HT) and noticed that the creatinine fluctuated between 1.1 and 1.3 (Gfr was always >60). The big jump to 1.5 (Gfr 50) was in July of 2015, and from there it increased reaching a high of 1.77 (Gfr 44), now 1.65. Sorry to say but I associate it with the climate change not me being old (LOL). Summers and winters are hotter now. BUN is normal at 42 mg/dL. The fasting blood glucose also increased from 87 to 103 mg/dL. Thanks for the tips regarding the foods I should avoid.
Rakendra; the link you provide is great for diabetics but does the keto diet improve kidney’s problems? I see the overweight condition in me as a risk factor to get diabetes, surely anything that contributes to lose weight will lower the risk, however I am still in safe, am I? I wonder if I should line up alongside you in the next Mr. Davao contest. Can your 6 pads beat my Michelin tire?

I appreciate receiving more of your comments, if any. They have helped me to look into the problem deeply and from different perspectives.

Thanks.

VG

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

http://robbwolf.com/2011/06/16/clearing-up-kidney-confusion-part-deux/ 

This should be right up your alley, because there is a lot over my head, but it surely answers your question.  I bleieve that there is a lot of previous thinking about diet that is now being reconsidered.  It appears that the old way of weight loss of lesser calories and more exercise is being debunked, as many weight losers regain rapidly.  When the body runs on glucose, the fat cells do not disapper, the just shrink for a while and then fill up again.  When on a Keto diet, the fat cells disappear because the body is now using fat for energy, not glucose.  Keto is NOT a high protein diet.  It IS a high fat diet.  70% fat and 20% protein is still a low protein diet.  I eat much less protein than before as a bodybuilder, but I STILL eat five to six times a day.  I make high fat drinks with cocoanut oil (No. 1 source of fat) and butter No. 2 source of fat. A meat eater has a much easier time, as there is duck fat, pork fat, and high fat beef available as well. Acutally, there are menus available for the Keto diet which are very acceptable. However, for a Keto Vegan bodybuilder the choices are not so diverse.  I know bodybuilders who cannot stand a keto diet.  It is too much of a change of lifestyle.  For me, my life works best when there is discipline and self respect.  I get A LOT of that with my intense gym workout which many have tried but which none have succeeded.  Matrix is just TOO intense for most people.  There is a misconception in the body building world that if you lift heavey, you will get big.  It should be if you heavey WITH NO CHEATING MOVEMENTS, you will get big.  Of course, the guys with Natural inherited genes get big no matter what they do, especially when they add Roids.  Five time Olympia winner Jay Cutler, benched 300 lbs the FIRST time he was in the gym.  I am not claiming that I can compete with guys 40 to 60 years younger, that is impossible.  I compete only to inspire others by my example that there is a better path that can be chosen.  But, of course, no one will ever change unless they are totally desparate.  There is SO much help available now, but so few who are simply afraid to take a chance.  Well, I digressed here alot.  Fear and faith are the only two choices.  Sadly, most live in fear.  And as long as I am preaching, here is a quote from my Spritual Master, Osho.

  

Continue to meditate, and continue to dance and sing. See life in as many ways as possible, in all its colors. Celebrating, you come closer and closer to the heart of reality. The moment you stop celebrating you are cut, disconnected. Celebration is the bridge. When you dance, it is not only you who is dancing; the whole existence is dancing with you – the earth and the sun and the moon and the stars. It is a celebrating existence… it is continuously dancing.’’  
     

 Love, Swami Rakendra 

All ways celebrating, always celebrating

Osho, 
Believing the Impossible Before Breakfast, Talk #28
bella3
Posts: 25
Joined: Jan 2017

Your potassium (primarily in vegetables) and phosphorus (meat, beans, nuts, dairy) levels are well within normal so you do not have to worry about restricting the foods, many of which are very healthy.  In someone with much much lower function these minerals aren't filtered out of the blood or regulated properly and build up causing other problems.  In a quick search, your adalat does not appear to stress the kidneys but aspirin or any nsaid is not advised.  I'd discuss it with your oncologist and a nephrologist to determine the risk/benefit.  Re the simvistatin, it is recommended that a coq10 supplement be taking if your taking a statin.  I do not remember the reason.  Ubiquinol is the best absorbed type of coq10.  

As for improving your gfr, it is not easy but home cooked, real unprocessed food, low salt if your bp is at all high.  1/2 or more of your plate veggies, 1/4 chicken or fish, 1/4 whole grains. Avoid sugar or baked goods :( Continue drinking a lot of water.  i understand these are all comprise a healthy pic diet as well.  A nephrologist could also help set up an appointment with a renal dietician, but may not feel it necessary since your kidneys are still strong.

Best to you!

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

 

Rakendra; Thanks for the link. It is very interesting and intuitive. The comments by readers complete well the article and clarify many doubts. I once was careful about diets when the famous Fit or Fat book was around in the 1980th. Its principles attracted me and I was fascinated regarding the metabolism involvement in changing “fat” into “fit”. I wasn’t overweight at the time but liked the way it explained on how physical activity consumed fat. I never followed their nutrition advices. Your comments regarding the keto diet is welcome. I am not sure if I would follow such advice fully as I am not yet desperate. I may restrict some of the actual intakes and be more careful with fructose. I need to study to get the full meaning on the suggestions of the article.

 

Bella; thanks again for the analysis of my condition. I value your experience and comments. I felt peace of mind when you read “...your kidneys are still strong”. This is something I want to believe but cannot evaluate. Next week I am meeting a nephrologist.

 

Thanks

VG

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3227
Joined: May 2012

vasco,

I am sorry you are having your current difficulties.  If anyone can find a workaround, it will be you.

I have had numerous friends/neighbors who had kidney failure and even went on dyalisis. Your data are miles away from that happening to you, probably ever.

Without studying the many details you provide, it seems your issue is primarily the urinary problem effecting your availablity to use the HT drugs. There is surely a solution; keep digging !

max

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

Hello Friend,

You are treading on turf upon which I have not trod. In other words, I do not understand the change in your condition that you are describing. 

I wish you the best of good luck in overcoming this new hurdle the bandit has thrown onto your path.

I am pleased to tell you that I continue to do well. (For those who may not know it, I am a 25-year prostate cancer survivor. At age 90, life continues to be good.)

Old-timer (Jerry)

bella3
Posts: 25
Joined: Jan 2017

I happened upon this list of supplements that may be harmful to kidney function...

http://cjasn.asnjournals.org/content/2/4/757.full

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

Thanks Bella for the concern.

The situation doesn't allow me peace of mind. I have been reading and collecting past data (blood markers and exams) to prepare myself for the nephrologist consultation. I found a clinic that includes also cardiologists that may help me in understands better the facts. Any feel makes me think that it is related to the kidney problem. I read that high blood pressure may damage the kidneys or vise versa and found that I have hypertension.

I used to check the blood pressure once or twice a year (the results always close to the 125/85 parameters) but because of the present conflicts I start taking it every morning (before breakfast and pills) and the numbers are high varying with the systolic pressure going from 136 to 168 and the diastolic pressure from 88 to 100. I think that the daily Adelat 30 is doing nothing. Loads of question marks.

The radiologist gave me his CT report yesterday confirming the existing cysts in the left kidney, one now at 7.6 cm. He describes the liver with two biliary cysts in each lobe, one with 3.7 cm. The biliary track is normal and the pancreas and gallbladder are all homogeneous and within the normal parameters.
In regards to the kidneys he comments seeing them with normal shape and dimensions, and with proper parenchymal thickness, with no evidence of stony formation (hyper dense lithiasis). There are no signs of hydronephrosis (urine retention). However it comments that without the contrast agent they could not verify the presence of solid lesions that could be analytical influential. I wonder if such could mean that they cannot diagnose Renal Parenchymal Disease.

The collon is OK but shows diverticulitis at the left side. The bladder is not so conclusive but it indicates that there is moderate homogeneous Diffuse bladder wall thickening (which could signify the presence of infectious cystitis or cystitis from radiation  (RT scars).  Regarding the iliac veins and distal abdominal aorta they found arteriosclerotic calculi (extremity claudication). I guess that this could be the trash not filtered in the kidney or the reason preventing the transport of the trash by the blood to the kidneys.
Lymphatics are clean (no apparent PCa metastases) and no fluids in the abdominal recesses (prostate bed).

Overall it is a good result but limited to a CT capability (cannot detect a bandit producing PSA=1.5). The lack of contrast does not assure proper definition of solid lesions.

Thanks for the link on supplements. Artiminicin is in the list and this is a plant I think good in the fight against cancer. As you commented above, I am returning my habits and give preferences to home cooking, trying to avoid salt, cutting on bread and eating more vegetables.

Best wishes,

VGama

bella3
Posts: 25
Joined: Jan 2017

There is a lot of reassuring news there. My dad has one kidney with the right kidney removed in 2004 after blood in his urine and a scan showing a tumor which was later determined to be benign.  He's had undermanaged high blood pressure and diabetes for some time ( until I moved nearby and took over his care).  They both very common causes of impaired kidney function.  His ultrasound today showed several cysts in his remaining left kidney

My main point to you is that he has lived virtually symptom free for many years with one poorly functioning kidney.  His bp and blood sugar are managed but still above normal because it would further stress the kidney to medicate too aggressively. We attribute his good quality of life to exercise, diet and calm, positive temperament.

There is a lot of info online regarding natural ways to reduce bp.  I like breathing exercises, hibiscus tea.  Your doc may offer different bp meds.  I know you will do your own research to double check whether they are metabolized via the kidney which is not advised.  

You mention claudification.  Do you mean calcification?  My understanding that that is common with age and not necessarily worrisome.  Do you know about Bragg's apple cider vinegar?  A few teaspoons in water each morning.  I'll try to find a good link.

best to you!

 

bella3
Posts: 25
Joined: Jan 2017

An ok source but it gives you an idea..

http://www.livestrong.com/article/114578-health-benefits-apple-cider-vinegar/

 

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

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

Old Salt
Posts: 720
Joined: Aug 2014

It looks pretty convincing. But the specialist has given you hope that by changing some of your lifestyle, and adjusting the medications, further problems can be prevented.

Good luck!

bella3
Posts: 25
Joined: Jan 2017

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.

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

Here is another article on Keto diet and kidney disease, just recently published.  Clearly definitive results are still out.  https://healthimpactnews.com/2011/low-carbohydrate-high-fat-ketogenic-diet-may-reverse-kidney-failure-in-people-with-diabetes/

The only  part of your posts that I can understand is that there is a kidney  problem as well as a pre-diabetic condition and that your past diet and exercise program have not been the best  choice.  I do not know if the keto diet would be good for you, there certainly are two sides of opinions.  I am always skeptical of a medical industry which is very quick to decide on generally not so effective treatments that may also cause further problems.  I think you will do exhaustive research to come up with your own answers, so I am adding thses ideas again.  

About your exercise program.  Matrix has come up with a very effective change in their Matrix combination ladder of workout repetitions.  If any kind of muscle building program is in order for you, Matrix may be a good suggestion.  However, other exercise programs may include endurance and fitness programs which do not rely so much on strength conditioning buy more on fitness.  The correct decision will not be easy to come by because there are so many different ideas and programs.  I would suggest you Youtube Ron Laura Matrix and you will find a lot of info.  As you know, I am an 85 YO man who has been castrated and has Stage 4.  In this situation, a man has NO chance to ever put on muscle, but Matrix has been successful for me and combined with the Keto diet, the results are truly amazing.  Anway, I am not sure if this input is apropriate in your situation, but you always share your knowledge so accurately and freely,that I must try to help in any way I can.  Best wishes for a full recovery.  Also, I would add that if you do not have a formal meditation program other than your tree pruning, you are really missing out on a life style that can be very positive for you.  Love, Swami Rakendra

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

I am still wondering what may have been the cause of the high creatinine in blood and why the kidneys present a low filtration rate. The nephrologist and Denistd above say it to be related to age. But kidney problems occur at any age and it seems that the creatinine level can be regulated via body chemistry. The medical community diagnoses a kidney disease as chronic (CKD) when those markers show evidence of continuous dysfunction. This is a sort of permanent status with no return obliging specific care to avoid deterioration. However, it seems that one may improve the status via medication and changes in the life style, turning around the creatinine levels and clearance rates.
Could the CKD diagnosis be premature?

I have been reading a lot on the matter and am thinking that I may have still a chance in turning my case around to a healthier status closer to previous conditions. I understand now better the meaning of a misbalanced diet messing up with body’s chemistry as commented by Will and xNTP. This could be an issue that may still be adjusted via a controlled diet (as suggested by Bella) or a drastic change in my life style (high fat diet and fitness program) as introduced by Rakendra. Is there anybody that succeeded in getting out of a CKD diagnosis?

The nephrologist wants to see me back after a period of three months under controlled BP and lesser salt intake. He did not provide details, however he prescribed me a drug (co-Diovan 80/12.5 =Valsartan + Hydrochlorothiazide) whose leaflet, for my surprise, warns for not be taken “if you have severekidney disease or impaired kidney function”. The FDA site also informs that acute renal failure can be caused by drugs that inhibit the renin-angiotensin system and by diuretics. He may be seeing my case as not that advanced though the eGFR indicates a function at 45%.
Surely, I need a second opinion but will wait to have it after this period of “trial and error” proposed by the nephrologist. I will have more information in hand and will be better prepared to make questions.

Mean while a friend urologist surprised me with a comment when I meet him and other golf buddies on the week end. It meant to be a chat over golf but our encounter turned more into a sort of renal consultation with a group of several specialty doctors. Interestingly not all knew details on CKD and only a pediatrician and a GP knew that creatinine clearance tests are used upfront to evaluate kidney function. One neurologist become very curious regarding the prohibition on contrast agents, the urologist (a retired surgeon) commented that kidney affairs are taken by urologists as an added specialty just like oncology. In other words, neither a nephrologist nor an urologist knows the overall details unless these have studied subjects of each other specialty (including cardiovascular influences). Hands-on-the-job (experience) seem to be the most important aspect to consider when choosing a specialist for kidney issues. One engineer in the group with CKD said being on restriction diets and medications to control his renal deficiency via body’s metabolism. He said that golf makes part of his doctor’s recommendation as a moderate physical fitness. I though it being an excuse to his wife but later I read that moderate physical exercises are recommended instead of stressful ones for CKD patients.

Other aspect I read and need to consider in kidney issues is the PCa treatment(s). The effects of ADT in my endocrine system also affect the kidneys. Fitness and diet that will be behind my job in avoiding deterioration are manageable but leuprolide (Eligard, Lupron, etc) or antiandrogens (Casodex,etc) will affect the normal functioning of the thyroid and such will influence body’s metabolism causing more trash to be filtrated by the impaired kidneys. In fact the real roots of my condition could be an intercalated affair of past events (not only aging) and nobody can single out one solo offender by a simple snap-shot on the matter.

As a counter attacking measure, I have idealized one model based on your suggestions in diets and physical exercises, that I will inform in my next update. I have gathered details on foods (nutrients) that will influence the chemistry in the body. I also did some research on image studies and how they help in diagnosing a worse case of kidney failure.

Best wishes to all.

VGama

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

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
Posts: 25
Joined: Jan 2017

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.

Gleason Score 9...
Posts: 62
Joined: Nov 2016

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

tarhoosier
Posts: 195
Joined: Aug 2006

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.

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

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
Posts: 720
Joined: Aug 2014

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.

Subscribe to Comments for "Bad News: Renal insufficiency"