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.

Symptoms of failure vary, depending on the type experienced. Diagnosis can be difficult for a physician because symptoms and complaints can be attributed to other, unrelated symptoms. I will cover a few possibilities.

Stones form when the accumulated urine in the kidneys contains too high a concentration of uric acid, calcium or oxalate. Low levels of citrate and magnesium can also contribute to the formation. While there are four types of stones, the most common are the result of excess calcium. This can result from some prescribed diuretics, the ingestion of large amounts of vitamin D, dehydration or from excess hormones — specifically thyroid and/or parathyroid.

Pyelonephritis is a common kidney inflammation. This disorder is rather common in women but can also occur in conjunction with kidney stones, bladder tumors, urinary infections or an enlarged prostate gland in men.
Chronic kidney failure can occur from injury, blocked blood vessels, or can be the result of complications from a surgical procedure. Chronic failure occurs when the function of the kidneys has decreased to less than 25 percent of what it should be. With acute or chronic failure, waste products build up in the blood and cannot be eliminated.

Symptoms include loss of appetite, nausea, vomiting, drowsiness and a decrease in urine output.

Treatment consists of determining the cause for the failure, controlling infection and prescribing diuretics. In extremely advanced cases, dialysis may be necessary.

Your failure may be the result of diabetes, hypertension or untreated or repeated kidney inflammation. Make an appointment with your physician or a nephrologist to determine what can be done to bring things under better control.

While I understand you have already requested a copy of my Health Report “Kidney Disorders,” other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order to Newsletter, PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.

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.

The kidneys filter waste and excess fluids from the blood that are excreted in urine. With chronic kidney failure, waste products cannot be eliminated as readily, resulting in an accumulation in the blood. This causes dangerous chemical imbalances to occur. While there is no cure, treatment can help reduce any complications and slow the progression of the disease.

Treatment might begin with controlling the hypertension, taking prescription drugs to lower cholesterol levels, supplementing calcium and vitamin D to protect your bones, diuretics to rid the body of excess fluid buildup or the inclusion of a low-protein diet. A dietician will likely be recommended to review your diet and suggest methods by which your kidneys will not have to work so hard. This might include reducing your salt intake and eating foods lower in potassium. What your first nephrologist recommended was to have you incorporate a diet that would reduce the amount of work required of the kidneys.

Protein reduction includes lowering the amount of red meats, eggs and milk products in your diet. It’s not necessary to delete them, but to lessen your consumption. Fresh fruits, vegetables, cereals or breads might act as substitutes. Foods high in potassium include bananas, potatoes and tomatoes. An easy transition might be made to substitute apples, carrots, grapes and green beans. A sodium reduction can be accomplished by avoiding canned soups and vegetables, fast foods, processed luncheon meats, hot dogs, kielbasa, cookies made with tropical oils and countless other products. Here is where education and label-reading come into play.

Progressing to the later stages of the disease, dialysis, of which there are two types, might be recommended. The first is hemodialysis and involves pumping blood out of the body and into a machine that acts as a healthy kidney would. Once the waste is removed, the blood is pumped back into the body. The second type is peritoneal dialysis, which pumps a solution into the abdominal cavity and utilizes the body’s blood vessels to transport the waste products and additional fluids to the abdominal cavity, where the solution absorbs them. That solution is then pumped out of the body, taking the unwanted waste and fluids with it. A final option is kidney transplant from a healthy donor.

To provide related information, I am sending you a copy of my Health Report “Kidney Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Because my doctor didn’t discuss my lab work with me, I requested a copy from the front office of the clinic. I then looked up each value online and became concerned over several of the numbers. My GFR was 71. My BUN and bili totals were high. When I asked her about these numbers, she said she wasn’t concerned. When I pointed out that the National Kidney Foundation says my GFR level indicates stage 2 kidney failure, she told me that she doesn’t look at that number, and I shouldn’t worry because I was probably just dehydrated on the day of the blood drawing. She proceeded to ask which office worker had given me a copy of my lab work — as if I didn’t have a right to see it. She didn’t outright say that I shouldn’t have it, but it was clearly implied that I should not have gone online for information.

Should I be concerned about the results and continue to press my doctor into ordering more tests? Or should I just take her word for it that those numbers don’t really matter?

I believe that I should be proactive in my own health care, but am I pushing too far? I’ll add that over a year ago, I complained to her of horrible stomach pain each time I ate. It took me several visits with the same complaint before she finally ordered tests, which were positive, and another six months before further testing was done.
The pain had resolved before the tests were done, but I was told that I had to undergo them any way. They were negative, so I was told I probably had an ulcer that resolved itself.

Should I wait and see if my liver and kidney test results resolve themselves? Do I have any reason not to trust this doctor? Or am I just being paranoid?

DEAR READER: I have reduced the size of your letter owing to space restrictions but will attempt to cover all your concerns.

In my opinion, your physician is failing to provide adequate, timely medical advice. I recommend you sit down to discuss your concerns and disappointments regarding how she is handling your medical care. Express your desire for her to take your complaints more seriously, and if she is unwilling to change her habits, seek out a new primary-care physician who meets your standards.

As to your stomach pain, I am inclined to agree that it was a spontaneously resolved ulcer, but because of the delay in getting proper testing, you may never know. If your physician was truly concerned about your symptoms, she should have gotten into testing sooner.

Bilirubin is caused by the normal breakdown of red blood cells in the liver. You claim to have a lesion on your liver and an elevated bilirubin, which may indicate liver damage. This is reason enough for referral to a specialist or at least further testing to determine what the abnormality is.

Both blood urea nitrogen (BUN) levels and glomerular filtration rates (GFR) are related to the kidneys. The BUN indicates how well they are functioning, with high levels, suggesting reduced function. The GFR is an indicator of what stage kidney failure a patient is in. Lower GFR numbers imply greater damage and lower functioning. Because you are on a diuretic, this could be causing your abnormal results. With both these tests pointing toward kidney damage, you should undergo further testing or be referred to a specialist just to be on the safe side.

In my opinion, you should not wait to see if your numbers resolve on their own, because both kidney and liver damage can be extremely detrimental to health. The sooner a proper diagnosis and, if necessary, appropriate treatment are received, the better the outcome is likely to be.

I applaud your belief that you should be proactive in your own health and wish that more people believed this as well. I do not believe that you are being paranoid, given your remarks about your physician’s past behavior. Talk to her about your dissatisfaction or find a new physician who will work with you.

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.

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.

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).

Do you have any suggestions?

DEAR READER: Thank you for including your lab results because they tell the story. Your kidneys do not appear to be functioning properly. As a result, they are not excreting as much potassium as they should. Your blood urea nitrogen (BUN) is quite high at 60. It should be below 20. Finally creatinine is also high (2.1). It should be under 1.0.

Hypertension and, especially, diabetes, can also cause kidney disease. It may also be secondary to one of the medications you are taking. I recommend that you be examined by a kidney specialist (nephrologist) who can test you further. He or she can suggest treatment options for you.

Good luck and let me know the results.