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.

He has survived Hodgkin’s Lymphoma (1988), a 5 way by-pass surgery (1991), stroke (1997), and two carotid artery surgeries (1997 and 1998). He has type two diabetes as a result of his lymphoma chemotherapy. He is in kidney failure, was diagnosed with bladder cancer in 2005 and myelodysplasia.
He regularly sees an oncologist, endocrinologist, nephrologist, urologist and cardiologist. His medications include pain relievers, blood thinners, cholesterol reducers, calcium, vitamins, water pills, and many more.

I would like your opinion. We have insurance which I am very thankful for. I respect his doctors and their opinions as I do yours. I am worried, though, that he is over medicated. I also am worried that if he stops any of these, it would be his end. He leads a fairly normal life other than sleeping a lot, but given the situation, I would expect this. He does not do much, cannot play golf and is no longer sexually active (even though he would like to be). It is just not possible for him to do the things he wants and enjoys the way he used to.

DEAR READER:
Your husband has several serious medical ailments for which he is taking various (and mostly appropriate) medications. In your list, I do see two medications that I believe could be safely stopped. Valtrex is given to individuals with genital herpes as an outbreak preventive or treatment. Because your husband is not sexually active, there is little risk of him passing this condition on to you. You also state that your husband sleeps a lot. I note that he is taking Lunesta which is a sleep aid. If he is getting more than adequate sleep (7-8 hours) I don’t believe he needs this. If he is taking it because he cannot fall asleep at night, perhaps this is a result of him sleeping too much during the day. Try to keep your husband as active as possible during the day and he should have no problem sleeping at night.

Before making any modifications, I suggest you discuss your concerns with his physicians. Perhaps they would be willing to set up a conference call or meeting at which you and your husband can discuss the necessity of his medications and whether or not any can be modified, reduced or stopped. It is important, given his various ailments, that all his physicians agree on medication modifications. Perhaps now is also the time to involve a primary care physician who can help you sort out his medications and treatments. This will also help in the future if his situation becomes worse. At that time he may wish only to have medication to make him comfortable. Your husband’s quality of life should be of the utmost importance and if he is not enjoying his life and is missing out on the things he loves, his is, in my opinion, suffering. This can also lead to depression.

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

I am still unsure about what happened. Could taking three Lasix a day have caused this?

DEAR READER:
I do not believe that the Lasix was the cause of your unpleasant experience. More likely, you had bladder dysfunction due to urinary tract muscle contraction.

I assume that your “kidney doctor” is a nephrologist. You should review your problem with him or her. I would hope that the specialist can suggest ways of over coming the spasm if it occurs again.

To give you related information, I am sending you copies of my Health Reports “Bladder and Urinary Tract Infections” and “Kidney Disorders”. Other readers who would like copies 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).