Possible Kidney Disease

[Daveironbear]

I have experienced a lot of symptoms of kidney problems for the past two months. I am tired all the time, very fatigued and have shortness of breath. I generally feel like crap because of nausea. Some days I am cold and have chills. Sometimes I have to go all day long and urinate very clear urine. Some days I hardly go at all its like the Lasix that I take has no effect. My urine has blood and proteins in it. My urine is always foamy. My feet and ankles are swollen. Recently when this thing started fluid started to collect right under the skin between my knee and ankle. I had several places where the resulting blister was about 5 inches long and about 2 inches wide. I have low back pain and pain radiating down my leg. I have been treated fo Prostatitis and an enlarged prostate, it has not done any good. Last week a ultrasound indicated a rather large lesion on my right kidney and the radiologist recommended an CT scan to get further definitionto determine if it is a cyst or a tumor.
What should I ask my urologist?

[Beth Witten MSW ACSW]

The symptoms you report -- swelling in your legs, blood and protein in your urine, foamy urine -- are signs of kidney disease. You say you're seeing a urologist. It might be a good idea for you to see a nephrologist (kidney specialist). You could ask your urologist for a referral. Have you had testing of your blood for kidney function? If not, this is something that is pretty standard when someone has the symptoms you report. The results from blood tests they run can be entered into a calculator to obtain the glomerular filtration rate (GFR). The GFR level tells what percentage of kidney function you have.

A GFR of 90 or higher is normal but someone could be at risk of kidney disease because he/she has diabetes, hypertension, or because of enlarged prostate or the lesion you report.

A GFR of 15 or less means kidney function is about 15% and is classed as kidney failure. There are stages in between.

I'd also ask the urologist what is the plan for treating the enlarged prostate and the lesion on your kidney, what the side effects of that treatment are, what you need to do to protect your kidney function so far as the medicines you're taking now (or should be taking), whether you should reduce the salt in your diet to reduce the swelling in your legs, etc. You might want to look at the packet of information on chronic kidney disease on the Life Options website and read about kidney disease and treatment on Kidney School. The links to these websites are in my signature.

[Daveironbear]

Thanks for the info.

So far both the walk in clinic I saw first for this problem and The Urologist my family doctor sent me to has jumped on the Prostate. I was put on Bactrim DS for two weeks and referred back to my family doctor by the Walk-in clinic I initially saw. My family doctor found the blood and protein with a routine urine test. He did a PSA test and it came back negative. (They have a good baseline established when I was 55...there was no significant change.) So apparently there is no prostate Cancer.
The Urologist verified the blood and protein. He also determined that I Have a mildly enlarged prostate and prescribed Uroxatral. I have been on that for about a week but all it has done so far is run my blood pressure down.
The urologist has a cystoscopy scheduled in about two weeks. So far he hasn't followed up on the CT scan. Nobody has done a kidney function test.

I can get my family doctor to refer me to a kidney specialist.
The kidneys checked out good three years ago.
All of this is scary because I have diabetes, high blood pressure and was exposed to Agent Orange. I keep my blood pressure under control with medication and take, I think, Catapres to help my kidneys. My blood sugar has been erratic during the time this problem has been going on.

[Beth Witten MSW ACSW]

Guidelines for diabetics with kidney disease recommend two classes of blood pressure drugs: ACE inhibitors (ACE stands for angiotensin-converting enzyme) or ARBs (angiotensin II receptor blockers).

Here's a website that lists several ACE inhibitors:
http://health.msn.com/encyclopedia/medications/articlepage.aspx?cp-documentid=100065881

Here's a website that lists several ARBs:
http://health.msn.com/encyclopedia/medications/articlepage.aspx?cp-documentid=100072831

You mention Uroxatral. It is used to treat benign prostatic hypertrophy (enlarged prostate). It is an alpha blocker, which is another class of blood pressure medicines that the FDA has approved for BPH. Here's info on this drug:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500487.html

I wouldn't be surprised that your blood sugar is bouncing around. It's possible it's related to the BPH or it could be related to the stress you're probably under. You might also ask your doctor or pharmacist if any of your drugs could be affecting your blood sugar.

[Daveironbear]

I think that I have them pointed in in the right direction. I went back to my family doctor and went over all of the symptoms that I have experienced over the past two months. They did anther urine test and there was still blood but the protein was off in the weeds. Doctor Bob said that level indicated by the test strips was so high that the blood test would surely be off the chart also. He ordered bloodwork to check it. Also he ordered a kidney function test, test for anemia, a liver function test ... the whole nine yards. He is even checking for Rocky Mountain spotted fever. So hopefully we can get to the bottom of this. Thanks so much for the information

[Daveironbear]

Yesterday I found out what part of the Kidney problem is:
I have a 68X53 mm tumor on my right kidney and a smaller 24X30 mm on my left.

[Beth Witten MSW ACSW]

That could be the cause of the problem. Do they know if the mass is benign or malignant? What are your options for treatment?

[Black]

Yesterday I found out what part of the Kidney problem is:
I have a 68X53 mm tumor on my right kidney and a smaller 24X30 mm on my left.

Dave, do they know for certain whether they're tumors, or could they be cysts? My husband has polycystic kidney disease, and if he only had two cysts he'd be celebrating.

[Daveironbear]

The smaller one on my left kidney is classified as a benign fatty tumor, there is a similiar one on my left adrenal gland. They have decided that the lesion on my right kidney is a large cyst. This thing has gotten quite large in the past three years. Fortunately, there is no history of polycistic disease in my family. Hopefully once they get through all of the tests maybe they can diagnose what is wrong and what to do about it.

[DoriSchatell]

Dave, have they told you what your percent kidney function is? Regardless of the cause, it's important for you to know. They may also call it your GFR (glomerular filtration rate).

[Daveironbear]

The only thing that I have seen is the print out of all of the test that were run two weeks ago; it had the GFR listed as greater than 60.

[Beth Witten MSW ACSW]

If your GFR is 60, it's likely that you're in Stage 1 or 2 chronic kidney disease. If you have your lab test results, you can calculate your own GFR more precisely using one of the online GFR calculators. Simple and more complex calculators can be found at:
http://nephron.com/cgi-bin/MDRD_GFR.cgi

[Daveironbear]

GFR=66

[DoriSchatell]

Hi Dave,
I'm glad you've found this out--and very glad that it's still quite high. Now that you know what your GFR is, you'll want to track it over time (at least once a year or so) to see if it stays the same or gets worse over time. And you'll want to take steps to protect your kidney failure, like:
-- Avoid NSAIDs (non-steroidal antiinflammatory pain pills, like ibuprofen, alleve, etc.)
-- Quit smoking if you smoke
-- Keep your blood pressure to 120/80 or below
-- If you have diabetes, keep your blood sugar in the normal range
-- Ask for special precautions if you have X-ray tests that use dye
You can read more about how to protect your kidneys on the Life Options site, at: http://www.lifeoptions.org/kidneyinfo/ckdinfo.php.

Apart from that, your symptoms still sound as if they are caused by kidney problems, but most people who have as much kidney function as you do don't have symptoms. So, if I were you, I'd keep working with my MD to see what's going on and treat it.

[Daveironbear]

I just got in from my Urologist's office. The results of the 24 Hour urine test confirmed Albumin and large amounts of other proteins in my urine. He said that when the kidneys are not working properly a lot of protein can spill over into the urine and he thinks that also explains the blood too. He is sending me to see a kidney specialist next Tuesday and is going to send all of my tests and the CT scan results to him. He did say that the good news was all of the urological evidence looked good...no problems there and the large lesion on kidney is just a large cyst.

[Beth Witten MSW ACSW]

I'm glad that you have an appointment with a nephrologist so soon. The sooner you see the nephrologist, the sooner he/she can review your records, your medications, your diet, your lifestyle and try to figure out what to do to protect your kidney function.

[Daveironbear]

The doctor obtained my records from 2003 until now. My test a year ago done while I was in the hospital to have a toe amputated due to a nasty infection that had gotten in the bone was 800 mg. The latest 24 hour test revealed a level of 3500 mg. He is looking at diabetic nephropathy as the root cause of the problem. He wants to re-run the tests in a month to see if the levels have come down. he said that sometimes an infection can cause the protine level to go up and we don't know if I had an infection or not. My blood sugar level has been pretty good for the past 20 days. Kidney function looks good, GFR around 60.

He said that the dosage of Prinivil that I take was good. Based on the next set of tests we may want to add some medicine. He adjusted my Lasix dosage to be taken 1 tablet twice a day to help with fluid retention.
He wants me to get my eyes examined for diabetic retinopathy. We are treating the anemic condition. So, I think that we are on the right track and have caught this thing in time to prevent any more seriouss damage.

[DoriSchatell]

It sure sounds like you're right, Dave. Your doctor is being very thorough, and what he's recommending is in accordance with guidelines for kidney disease and diabetes. Getting and reviewing your past medical records is something all doctors should do--but many don't make the time for. IMHO, you have a keeper, and he's giving you excellent advice.

[Daveironbear]

Just an update my latest visit to the Kidney Specialist:
He ran all kind of test to rule out things that could cause my symptoms and the results were No Lupis, No Cancer...that was very good news. He has determined the root cause of my kidney problems is diabetic nephropathy. He put me on Diovan 80 mg to go along with the Prinival that I already take. My blood sugar readings have been in the normal range for the past two and half months so hopefully that will help the situation out considerably. My GFR is hanging in there around 65.

Thanks for all of the good info, it put me on the right track. Most people don't know how scary it can be when you start having kidney problems to go along with high BP and diabetes.

[DoriSchatell]

Hi Dave,

That is great news--and keeping your GFR in that 65 range could mean that you never need kidney replacement therapy. You're doing all the right things: staying positive (even though it's scary), learning all you can, and following your care plan. I wish everyone handled this the way you have been!