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TYPE2 DIABETES with raised CREATININE, weight loss. KIDNEY DISEASE?

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Hi, Doctor! I was diagnosed with type 2 diabetes in February, 1999 and I am being treated for hypertension; both conditions are presently controlled. I am taking Metformin, 2000 mg twice daily, Actos 30 mg once daily, Metoprolol 100 mg once daily,Triamterene 37.5-25 once daily, Lotrel 10/40 once daily, Lipitor 10 mg once daily and Ranexa 500 mg once daily. On August 25, 2014 I submitted blood and urine that returned September 9 with decreased eGFR (57) and slightly increased creatinine (1.35) and calcium (10.6). I was also mildly anemic (RBC 4.10, Hemoglobin 12.1 and Hematocrit 36.2). Urine virtually free of presence of protein (1.3), I told my family physician that, for ethical reasons, I had stopped eating meat 9 months before. I also began waling daily in January 2014 and lost 36 lb (I had weighed 250 lb and got down to 214). My Doctor thought eGFR/creatinine might be due to dehydration and anemia to absence of meat in my diet. She instructed me to drink 8 glasses of water and to add chicken/fish to my diet and she had me come in biweekly to get B-12 injections. She tested me again last week. I received my results today which showed eGFR dropped further to 49 and creatinine was 1.54.Slightly improved calcium (10.4). Anemia still present but a little better from last time (RBC 4.19, Hemoglobin 12.5 and Hematocrit 37.7). Urine still largely free of proteins (1.9). I lost another six lb.; down to 208 lb. My Doctor has now cut my daily Metformin dosage in half (2000 mg to 1000 mg) and reduce Lotrel (from 10/40 to 10/20). She instructed me to return in one month (instead of the usual three) for retest. Please let me add that on November 3 I had ultrasound done on my kidneys (I have history of kidney stones) and urologist advised that there was no indication of scarring or necrosis in my kidneys. I'm a 59 year old caucasian male. Doctor, can Metformin and Lotrel elevate creatinine and reduce eGFR if taken over time? In your judgement, could Metformin be the source of my test results? And can reducing Metformin and Lotrel resolve these issues? I'm frightened that I may indeed have kidney disease-please give me your impression/judgement of the history I've described above...thank you and G-d bless you. Please don't misunderstand; my Doctor is wonderful-I'm reaching out to you because of my own anxieties...

Category: Nephrologist

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Category: Pediatric Nephrologist
 22 Doctors Online

Hello,
Thank you for choosing DoctorSpring.
I understand your concern and I will try my best to help you here.
The elevated S.Creatinine and reduced e-GFR could be result of the effect Diabetes in the Kidney. This could be suggestive of Diabetic nephropathy. Metformin and Lotrel can have an effect on Kidneys but the probability is more for a Diabetic nephropahty. The urine protein will be normal in early stage. So you need to look for Microalbuminuria also. (to identify early protein loss). Weight loss and dehydration can also affect the values. The weight loss make me wonder about your blood sugar control. Is it well controlled ? How is your HbA1C levels ? Also may I know your blood pressure and the reason to take Ranexa ?
Do not worry though, if there is any diabetic nephropathy it can be well controlled and treated. You might need some modifications in the treatment plan and some more tests. I will suggest you a plan once I get to know the blood sugar levels.
Regards


Patient replied :

Thank you, Dr. Raju-my a1c as of 11/25 is 6.3; on September 9 it was 6.4 and in March, 2014 it was also 6.4. My weight loss was intentional-since January 2014 I've been walking daily and avoiding sweets and most starch-that's how I lost 42 lb and I continue to walk to further reduce weight. My blood pressure has averaged 124/82 over the last 3 months and is alway now 115-130 over 75-85 generally. I take my BP daily. In your judgement, would it be safe for me to resume light weightlifting with 10 lb dumbbells? And is there a chance that my eGFR, creatinine and kidney function can improve? please advise and thank you for your response!! I'm not sure why I take Ranexa-I don't have heart failure. My Doctor said it would give me more energy...finally, please tell me honestly , Doctor-can I still salvage my health, avoid dialysis and ESRD with proper modifications of diet and lifestyle? Thank you and G-d bless you!!


Hello,

Thank you for the reply.

DO NOT worry, you can salvage your health and have a good life. Or even better you might not only have a minor, reversible issue right now. First of all we need to do some more tests and you will need to modify your treatment plan. Ranexa should be reconsidered and even stopped in consult with your Doctor. (Indication ?). If the elevated creatinine persists a shift to Insulin from oral anti diabetics should be considered.

You need to do a test for urine microalbuminuria. Also monitor Urine protein and Creatinine. A complete routine blood (if not done already) and peripheral smear test also has to be done (to evaluate anemia) . A urine routine microscopy should also be repeated at the next cycle of test recommended by your Doctor. Make sure you are not doing sternous exercise atleast 2 weeks prior to next test. Avoid OTC pain medication as they are not good for the Kidneys.

If the values are elevated you should ask for a Nephrologist referral. You can also consider a referral now also.

Hope this helps
Feel free to ask followups
You can get back to me any time.

Regards


Patient replied :

Thank you, Doctor, for your wonderful advice. Best wishes to you and yours for a Happy Thanksgiving!!


Happy Thanksgiving to you too sir!!
Wish you great health from the entire DoctorSpring team!
Regards.


Dr. Sree Bhushan Raju
Category: Pediatric Nephrologist
Experience: 
FISN : Fellowship of Indian Society of Nephrology(ISN), 2012
FIACM : Fellowship of Indian Association of Clinical Medicin(IACM), 2012
FICP: Indian College of Physicians Association of Physicians of India, 2012
Fellowship: DM, DNB, All India Institute of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, Nizam's Institute of Medical Sciences, 1998
Medical School: MBBS, Gandhi Medical College, 1994
Dr. Sree Bhushan Raju and 4 other Medical Specialists are ready to help you

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