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.
DEAR READER: As you likely understand because of your meticulous note, you are taking allopurinol to control the symptoms of gout and Lasix to fight the leg edema. I will discuss both cases briefly for other readers before getting into my main concern regarding your conditions.
Allopurinol is prescribed to help reduce the production of uric acid in the body since a buildup can lead to gout and/or kidney stones, among other things. Side effects of the medication, when they occur, include easy bruising, nausea, weight loss, headache, diminished urination, and joint pain. Initially, I recommend you review your diet with your primary care physician and ask for his or her direction. If you consume seafood, mushrooms, organ meats, anchovies and drink beer, eliminate those choices from your diet as they contain high levels of purines which increase uric acid production. Instead, ask about including fresh fruits, vegetables, whole grains, tofu, the occasional cup of coffee and a vitamin C supplement. You might also ask about an additional medication to work with your allopurinol. The first will treat the attack, the second will prevent recurrence.
Lasix, otherwise known as a water pill, prevents the body from absorbing too much salt. The medication treats fluid retention, most commonly in individuals with kidney and/or liver disorders and congestive heart failure. Dosing should be strictly adhered to since excessive amounts can cause electrolyte depletion and excessive urine production and elimination. Common side effects can include constipation, lightheadedness, dizziness and diarrhea. Lasix and other diuretics are necessary in the treatment of edema and renal failure, but also increase the risk of gout. In your case, where you have both conditions, you are walking a tight rope and should be under tight control and carefully monitored.
Now, on to your kidneys which are a pair of bean-shaped organs in the middle of the lower back on either side of the spine. The job of the kidneys is to filter toxins and excess water from the blood and help regulate levels of minerals such as sodium and potassium. Kidney disease is progressive, with signs determined by something known as the Glomerular Filtration Rate (GFR), the rate at which kidneys filter waste. Stage 1 is assigned to mild kidney disease with greater than 90% kidney function. Stage 2 has a reduced GFR with between 60 and 89% kidney function. Stage 3 refers to moderate chronic renal insufficiency and refers to individuals with between 40 and 59% kidney function. Stage 4 refers to severe chronic renal insufficiency when a person has between 15 and 29% kidney function. Before I elaborate on your 40% efficiency, I will simply finish by indicating end-stage renal failure refers to function less than 15%.
The stage 3 you are in may make you fatigued. You may have had a change in your appetite. You may experience back pain in the mid-to-lower portion of your back or on one side or the other. Your blood pressure may be higher than normal, you may be short of breath and your urine output may be very light to almost clear. And, lastly, you may have edema that can be present first around your eyes, but is also possible in the extremities.
Unfortunately, renal failure affects many of us as we age but there are steps we can take at home that will go a long way toward slowing the progression of the disease. The first is to be on a low- sodium diet that will both help any hypertension and prevent fluid retention. Your diet should be low in potassium; therefore, avoid such foods as bananas, potatoes and nuts. When it comes to medications, either eliminate or take minimal quantities of aspirin, antacids and laxatives that contain magnesium and aluminum, certain decongestants, specific drugs for ulcers, and numerous prescription drugs, as well.
It appears that your primary care doctor and nephrologist are doing everything possible to keep you going so their lack of concern may be slightly misinterpreted. We tend to want a magic elixir to make us better overnight and when we don’t get it, we feel we have been slighted. If you haven’t been given direction on lowering the amount of proteins you consume and are taking in too much salt, you might ask for help through your local hospital’s dietary department. Sometimes minor modifications to a person’s diet are all that is necessary to jump start a person’s system and get him or her back on track.
Readers who would like related information can order my Health Reports “Kidney Disorders” and “Gout” by sending a self-addressed, stamped number 10 envelope and $2 (for each report ordered) US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.
