WWII vet with renal failure plagued with gout

DEAR DR. GOTT: I am an 86 year-old WWII vet in very good health. In the early part of last year I developed a bad case of gout for the first time. Several months later I slipped getting out of the shower and fractured my pelvis. I made a very good recovery from the fracture but my gout has persisted to this day. I have edema in both legs. I’m on Lasix 40 mg twice daily and allopurinol 100 mg. Most recently I started wearing compression stockings. My kidneys are functioning at 40% and have been stable for the last four years. PCM, nephrology and cardiology doctors don’t seem concerned but I am very worried since this condition has lasted so long.

I would appreciate your opinion regarding this condition and or any suggestions regarding my affliction. Sign me yours with gratitude.
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What was okay isn’t any more

DEAR DR. GOTT: I am a white male with a question about my creatinine history. In 2009 it was 1.09; in 2010 1.11; in 2011 1.15; and this year I’m 1.19. For the first three years of my testing, the reference range was between 0.67 and 1.54 but for some unexplained reason, the upper limit range was reduced to 1.18. Why?

DEAR READER: Reference ranges, otherwise known as “normal range” values are used by health care professionals to assist doctors and laboratory technicians in interpreting test results from blood, urine, cerebral spinal fluid and/or feces. Simply stated, the range calculated is determined through collecting data from countless numbers of tests, with 95% of the population falling within the “normal” range, and the remaining five percent falling out of that [Read more...]

Glutamine potentially harmful for some

DEAR DR. GOTT: In your column you’ve said people with kidney diseases should not take glutamine, but you don’t say why. I have GN with secondary FSGS and can’t find out why I shouldn’t take glutamine. Hopefully you can help me out.

DEAR READER: Before I get into the glutamine issue, I will first briefly explain what GN and FSGS are.

First, GN is an abbreviation of glomerulonephritis, a kidney disorder that causes inflammation of the glomeruli. These tiny filters are responsible for removing excess fluid, electrolytes and waste from the bloodstream for excretion through urination.

There are two forms, acute and chronic and a plethora of reasons why either may occur. Certain bacterial or viral infections, such as bacterial endocarditis, streptococcus and hepatitis B or C may be to blame. Some immune system disorders such as lupus, Goodpasture’s syndrome and IgA nephropathy or vascular conditions, such as Wegener’s granulomatosis or polyarteritis may lead to GN.

Symptoms vary in severity and may include hematuria (blood in the urine), high blood pressure, edema (swelling), fatigue due to anemia or kidney failure, and proteinuria (protein in the urine which may present with excessively foamy urine).

Treatment depends on the cause. For example, most acute cases caused by the streptococcus bacteria tend to improve without specific intervention. For those that do require treatment, anti-hypertensive medication may be beneficial. Treatment of the underlying cause, should one be found, will also help. For those with chronic disease dialysis (a procedure with a sort of external mechanical kidney to remove waste from the blood) or transplant may be necessary. Transplant is only an option for those with severe disease but who are still in good health otherwise.

Beyond that, a diet low in salt, potassium and protein is important to reduce the work of the kidneys. Maintaining a healthy weight and if diabetic, controlling blood sugar, will also be beneficial.

FSGS is focal segmental glomerulosclerosis. This condition is characterized by the development of scar tissue within the glomeruli. It is not a single disease, but rather a pattern of damage with several types being differentiated, based on which areas are damaged. It is relatively common, especially in the United States, and can only be diagnosed by kidney biopsy.

There are two forms, primary, which occurs on its own for no obvious reason, and secondary, which is caused by or is in association with another condition such as obstructive sleep apnea, sickle cell anemia, obesity, congenital kidney defects, urine backing up into the kidneys, certain viruses and more.

Many FSGS patients don’t have symptoms. Those that do may experience edema (swelling), increased blood creatinine levels, proteinuria, high blood pressure that is difficult to treat, sudden weight gain, have shoes that no longer fit, and more.

Treating FSGS can be difficult and it is important that those diagnosed be under the care of a competent nephrologist (kidney specialist). Regular monitoring of kidney function is vital. Immunosuppressant medications and/or certain types of anti-hypertensive drugs may be prescribed. With or without treatment, most will eventually require dialysis.

Now on to your question about glutamine. Glutamine is an amino acid, not only found in foods we eat, but that is also produced by our bodies. Deficiency is rare. Supplementation is not recommended for those with kidney disease or for anyone with reduced kidney function — such as the elderly — because it has been found to raise levels of certain substances which indicates stress on the kidneys. Those already experiencing kidney problems may speed worsening of functioning by taking this supplement.

Readers who are interested in learning more about the kidneys can order my Health Report “Kidney Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

When blood levels aren’t normal

DEAR DR. GOTT: This is being written with the hope you will help me to understand a medical issue. For the past 2 ½ years I have had quarterly blood tests to monitor my liver enzymes and cholesterol levels. In November 2010 these tests also showed my creatinine level was 1.3 and there was a notation from the lab that such was high. When talking with my doctor, he agreed and said we should monitor it. The test in February 2011 was 1.4 but in May it was down to 1.3 again. Then in the August test, it had jumped to 1.8. At first I was told this indicated something serious was going on with my kidneys and my doctor ordered additional blood work to rule out a lab error and help determine the cause. Then those tests were canceled and I’ve been told it’s nothing to worry about. Should I be worried?

DEAR READER: When creatine (important for the production of muscle energy) is metabolized, it produces a waste product known as creatinine, a compound that is produced in the liver. [Read more...]

Kidney-failure diagnosis can be tricky

DEAR DR. GOTT: I am an 86-year-old doctor’s daughter concerned that both my parents died of kidney failure, although I never knew how it happened.

Perhaps you could tell me what steps I should take first to deal with it, as I just got a report from my doctor indicating that I have chronic kidney disease that has stabilized. What does that mean?

DEAR READER: The kidneys are fist-sized, bean-shaped organs located at the back of the upper abdomen. Their purpose is to filter and clean blood. When the kidneys lose their ability to perform as intended, the condition is known as kidney failure. Stabilized failure simply means that your kidneys have lost some function but are no longer deteriorating.
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Chronic kidney disease carries dietary restrictions

DEAR DR. GOTT: I have been diagnosed with chronic kidney disease. I was shocked when the nephrologist told me this, as I have no symptoms. I decided I would get a second opinion. The second doctor said my first diagnosis was correct and put me on a strict low-sodium, low-phosphorus, low-protein diet with very few things I could eat. I went back to the first nephrologists, who said, with all the trials done on the kidneys, it was found that I wouldn’t live one day longer on the diet. She said instead to limit my protein somewhat and to watch my sodium. What is your feeling on this strict diet? I’m a 76-year-old woman. I am having surgery soon to provide an access, as it takes six months for it to heal so I can have dialysis.

DEAR READER: Chronic kidney disease is the gradual loss of kidney function. Conditions such as diabetes, kidney stones, enlarged prostate, vasculitis and hypertension are often associated with the disorder.
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Should reader find a new physician?

DEAR DR. GOTT: My doctor has told me that I have lymphedema and should take a water pill. When the 20 milligrams wasn’t sufficient, she put me on 40 milligrams. Because I wanted to know more about my condition to better educate myself about things to do and not do, I looked online. It appeared to me that my doctor should be looking for the cause of the swelling, not just treating it. So I pressed her into doing more. She ordered a CT scan of my pelvis, a heart echo and a venous Doppler. My CT scan showed a lesion on my liver and no abnormalities of the kidneys. The Doppler was negative, and I don’t have the results of the echo, even though it was done more than a month ago. [Read more...]

Daily Column

DEAR DR. GOTT:
My husband, who is in his 70’s, has developed a strong odor. It smells like hair that needs to be washed despite the fact that he showers and washes his hair daily. By the end of the day the smell is so strong that I can smell him from several feet away.

This has been going on for a couple of years and during that time he has tried several different types of shampoos with no change. He finally spoke to his doctor who didn’t know what to do. Please help.

DEAR READER:
There are various ailments that can cause a person to develop a strong body odor. One of the most common is kidney disease. I suggest your husband return to his physician for a complete exam and blood tests. Once the results are in, you and your husband should sit down with the doctor to discuss what they mean and if a referral to a specialist is in order.

Daily Column

DEAR DR. GOTT:
I read your column everyday and hope you can help.

My 50-year-old daughter has developed an allergy that causes a very itchy rash over her entire body. Tests have not determined the cause. She has been on prednisone and is now being weaned off. She has extreme pain over her entire body, especially her feet and is having trouble walking. She has been told that this is a side effect of going off the medication but that other tests cannot be carried out until her body is clear of the steroid.

Is there anything that can relieve the symptoms of withdrawal? Her job requires her to be on her feet most of the day and she is having a hard time functioning efficiently at work.

DEAR READER:
Severe itching can be caused by an allergy, but it can also reflect kidney disease or hidden cancer. Therefore, I suggest that your daughter have further testing performed once the effects of the prednisone have disappeared. To the best of my knowledge, prednisone withdrawal symptoms only occur if the drug is stopped abruptly or is tapered off too quickly. If her doctor is removing the medication too quickly, it could explain her pain. I suggest she speak to him or her and voice her concerns.

As an aside, the pain is a result of cortisol withdrawal. The body makes cortisol naturally until medication, such as prednisone or other corticosteroids, are introduced. Because the body makes only minimal amounts, the adrenal glands (which produce cortisol) shut down in the presence of the medication. It takes time for the body to resume its normal functioning . It can one week to several months to wean down properly from corticosteroid therapy.

Rarely, some individuals will not return to normal function, especially if the dosage and frequency are high and long. If this occurs, medication to replace the missing cortisol must be taken to avoid symptoms. If it is not, serious illness and death occur.

I suggest your daughter have blood work to test the function of her kidneys, a potassium level and certain cancer markers (available for breast cancer). A high potassium level (often caused by kidney disease) may be the culprit. If this is the case, I suggest she be examined by a nephrologist (kidney specialist). If her cancer markers come back abnormal she should be examined by her gynecologist or an oncologist. On the other hand, if everything appears normal, she should continue with the allergist.

If your daughter is having severe pain and side effects, she must be weaned down more slowly. If her physician is unwilling to do so, she should find a new one. Good luck and let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Daily Column

DEAR DR. GOTT:
As odd as this sounds, I promise this is not a joke. When my husband sneezes, the air he expels as an odor to it. I would associate it with the smell of marigolds or musty urine. We have noticed this over the course of the last month or so.

I offer the following information in case it has any bearing (but we believe not).

He has been diagnosed with colitis but it is under fair control with diet. (He has been fairly closely following your no flour, no sugar diet.) He does not smoke anymore, having quit four years ago. He is a mild/moderate social drinker. His lymph nodes swell up on occasion but I assume that is from fighting off infection. It does not seem to have any correlation with the smell. He also has heartburn and uses antacids a few times a week. He takes vitamin C regularly but no other multi-vitamin. We cannot think of any major dietary or lifestyle changes in the last month that might cause this bizarre occurrence.

We wonder if ammonia-smelling sneezes have an obvious cause and should they be something to be concerned about? Is this something you have ever heard of before?

DEAR READER:
Ammonia-smelling breath is a well-recognized consequence of diabetes, kidney disease and liver disorders. Don’t ignore your husband’s symptom. He needs to be checked. Although the ammonia odor may simply reflect inefficient digestion that is characteristic of colitis and other intestinal disorders, I worry that a more serious situation is developing. Get him to your family physician for testing and let me know the outcome.

To give you related information, I am sending you copies of my Health Reports “Living with Diabetes Mellitus” and “Kidney Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).