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Elevated BNP, GFR with CONGESTIVE HEART FAILURE, KIDNEY FAILURE.

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My 88 year old mother just left hospital and is in nursing home.
My niece sent me an email after reviewing test results of my mom while in the hospital.
Below is what my niece sent me - What should I do - I mostly do not understand this

Below is what my niece sent me
Here is what I see in the test results.

1. I see highly elevated levels of B-type Natriuretic Peptide (BNP) which indicates how well the heart is working. I see the diagnosis of Atrial Fibrillation (irregular heart beat) on 7/26 which can decrease the ability of the heart to work well. According to the Cleveland Clinic, normal levels of BNP are less than 99pg/ml, levels higher than 900pg/ml indicate severe heart failure. Mor Mor's test results on 8/5 were 1295pg/ml and on 8/6 they went higher - 1383pg/ml.

2. I see elevated levels of Blood Urea Nitrogen, an indicator of kidney function. Elevated levels can also be caused by UTI (which is clear now...), dehydration, and congestive heart failure. Generally levels range between 7 & 20 mg/dl. Mor Mor's test results show a continuous upward trend from 22 mg/dl on 8/3, increasing daily to 33 mg/dl as of 8/7.

3. I see her creatinine levels increasing and glomerular filtration rate (GFR) decreasing, both indicators of kidney function as well.

Standard levels of creatinine range from 0.6 - 1.3 mg/dl. Mor Mor's fluctuated between .95mg/dl (7/27) and 1.50mg/dl (8/7).
GFR is measured as a percentage of kidney function, standard being greater than 90. Chronic Kidney Disease is diagnosed at 6 different levels, 1 greater than 90% (normal), 2 greater than 59% (mildly reduced), 3A greater than 44% (moderately reduced), 3B greater than 29% (moderately reduced), 4 greater than 14% (severely reduced), 5, less than 15 (very severely reduced). Mor Mor's level on 7/23 was 39%. It has fluctuated as high as 56% (7/27), and has been declining since 8/5. Last test resulted in her lowest level - 33%.

Here is my concern...are any of the doctors talking about congestive heart failure or chronic kidney disease? If so, are they treating for it? I can't readily tell from the scrips she is taking. If not, why?? And what is her prognosis given these results?

If you send me the doc's info I would be happy to talk to them about it.

~me


Category: Cardiologist

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Category: Internal Medicine Specialist
Dr. E. Satish Kumar is online now

Expert:  Dr. E. Satish Kumar replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
From your case history ,it seems she has been suffering from heart failure , a condition best described as when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs further aggravated by age, atrial fibrillation ,risk factors like age , diabetes etc.
In her case both heart failure and chronic kidney disease are interlinked as in heart failure the blood supply is reduced to all organs including kidney ,drugs like fursemide which is commonly used diuretic in heart failure to remove excess fluid ,if she has diabetes it can effect both heart and kidney .
Having Atrial Fibrillation can also effect the heart failure and also reduced the cardiac output , so it has to controlled .If it is present for a short duration it can be cardioverted to sinus rhythm so as to improve cardiac function and if it is present for longer duration then the rate has to controlled and anticoagulants has to be given to prevent embolic episodes.
Looking to her age and others like high BNP and nephropathy , there usually have bad prognosis with recurrent admissions for heart failure or due to embolic episodes. She requires close monitoring with cardiologist , nephrologist and general physicians
Regards
Dr Satish


Dr. E. Satish Kumar
Category: Internal Medicine Specialist
Experience: 
Fellowship, Cardiology - Tamil Nadu Doctor M.G.R. Medical University - DNB, Cardiology, 2002 – 2005Training in Germany in Complicated AngioplastiesMedical School - Maharaja Krushna Chandra Gajapati Medical college, MBBBS MD, Int Medicine, 1989 – 1999.
Trained in Rota Abalation for treating Calcific coronary artery disease in Japan
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