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Monday, September 15, 2014
Should I Seek a Nephrology Consult?
I have high blood pressure, diabetes, cirrhosis of the liver Childs Pugh A, MELD 7, bipolar disorder and a host of lesser illness/conditions. I have taken lithium for over 10 years. I`m an insulin dependent diabetic and I take an ACE inhibitor plus diuretic for the blood pressure. There are other meds as well. For the last year at quarterly labs my liver enzymes are elevated (upper 60s), Bun consistently low at 6ish, Bun/Creat ratio 6ish, Alb right around 3.5, Creat ranging .9 to 1.4 over 4 different labs. I am female, white and 41. GFR`s are slightly low. (>59). My PCP thinks maybe consult. My Endo isn`t worried at all. My Hept isn`t sure and my Psych thinks I should consult. Should I be concerned with these risk factors and slightly low GFR`s to seek a consultation with a nephrologist at this point?
I would follow the advice of your PCP.
Thomas Zipp, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University