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Sunday, May 19, 2013
Do I Have Kidney Disease?
I am a 72 year old African American male. I considered myself in good health, until 3 years ago when I was diognosed with an enlarged heart and atril filbration. I was put on 20mg lisinopril, 50mg carvedilol and 4mg warfarin. I never had high blood pressure, and no diabetis even though run in my family. I am very active. I do hard labor type of work to maintain my ranch even today "workaholic." My diet is consist of big green salad every night. I am fond of sweets. I rarely eat red meat only chicken and fish sometimes. My cardiologist says I am doing excellent and keep up what I am doing.
However, my reqular doctor is concerned about my kidneys. The last 3 years when I take a physical he sends me to nephrologist for check up and nephrologist says nothing. I am concerned about my kidneys because my father died from kidney disease. There has been severe change in my test results since last year.
Creatinine in 2008 was 1.4 in 2009 1.9, BUN in 2008 was 11 in 2009 22, GFR-other in 2008 was 53 in 2009 37, GFR-African American in 2008 was 60 in 2009 45, my colosterol in 2009 is 144, triglyceride 76, HDL 32,LDL 97,ratio 4.5, TSH is 1.62. My blood counts are also low and I have a mild anemia.
I am very concerned. Should I be worried about kidney disease? Can you tell me if the medications I am taking are causing the changes in the test results? I am going to see the nephrologist in June and want to know what questions I should ask him. I know my diet is good as I am almost a vegitarian. My friends call me "Rabbit" because all I eat is salads. What else I can do to improve my health? I work from 8 in the morning until 8 in the evening. I do drink lots of liquids. I appreciate your advice.
I agree that your kidney tests are of concern, because they are abnormal and are becoming more abnormal. Your current tests place you at a stage 3 of chronic kidney disease. See the article called "Basic Information about the Kidneys." Also, because you have a family history of kidney disease, you are at increased risk for kidney disease.
Of the meds you list, lisinopril can sometimes cause an increase in BUN and creatinine, which are commonly-used measures of kidney function. Please see our article on "Kidney Tests."
Another possible cause of your abnormal kidney tests is your heart condition. Since you have an enlarged heart but no high blood pressure, I am wondering if you have some degree of heart failure. If so, this may affect your kidneys because your heart may not be pumping an adequate blood supply to your kidneys. There are tests that may help to tell whether your low GFR is due to heart failure or to actual kidney disease. These include a kidney ultrasound, which may show normal kidneys if the problem is heart disease, but will show small scarred kidneys if the problem is kidney disease. A urine test for protein will also help determine the degree of kidney damage.
I agree with your regular doctor that you should be worried about the condition of your kidneys. You deserve to have a nephrologist who will thoroughly discuss your condition with you; so if you feel that the current one is not giving you enough information, ask your doctor to refer you to a different one. Good luck to you, and please feel free to write again if you have more questions.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University