IS DECREASED KIDNEY FUNCTION REVERSIBLE?

[meldanad]

I have moderately high blood pressure. My doctor recently changed my prescription for blood pressure tablets from Atenolol to 150mg Irbesartan (I live in the UK so maybe these tablets arent known by these names in the US?) as a blood test I had several weeks ago showed my kidney function as only 48%. My doctor was convinced this result was incorrect and sent me for a further test. This time the result was still only 50%! Needless to say I was very shocked by this as I am extremely fit and well and do not lead an unhealthy lifestyle but apparently there are no symptoms for kidney disease in its early stages. My doctor told me that taking irbesartan would protect my kidneys but the literature with the tablets says that taking these tablets could actually cause kidney disease. I am very confused and worried by this and also wonder why the first test showed a kidney function of 48% yet the second test should a slight improvement of 2% Why would this happen? Is there anything I can do to prevent a further decrease in kidney function?

[Beth Witten MSW ACSW]

I can only imagine how frightening it must be to learn that you have kidney disease. You don't say how long you've had high blood pressure, but over time, high blood pressure can damage kidneys.

In the U.S., hypertension is the second leading cause of kidney failure. Once kidneys are damaged, the goal is to prevent or slow progression of kidney damage. Results of tests may vary slightly from one time to the next, but it looks like you may have about 50% of normal kidney function. Most people have no symptoms at this point, so it's really good that you learned this now so you can do all you can to keep protect your kidneys.

I'd suggest you make an appointment to see a kidney specialist (nephrologist). Nephrologists usually keep up-to-date on clinical practice guidelines for treatment of conditions that can cause kidney damage and kidney failure. Sometimes kidney damage can cause blood pressure to go up when there are blockages in the renal arteries that carry blood to the kidneys. You might want to ask your doctor whether there is any possibility that you have this problem.

The National Kidney Foundation (U.S.) developed guidelines in 2004 on hypertension in chronic kidney disease. You can read about medicines that are recommended for people with high blood pressure and kidney damage and lifestyle approaches to reducing blood pressure:
http://www.kidney.org/professionals/kdoqi/guidelines_bp/index.htm

Some lifestyle changes you can make to protect your kidneys include monitoring your blood pressure to be sure that the medication that you're taking is controlling it, losing weight if you're overweight, stopping smoking if you smoke, learning how to handle stress of everyday life, limiting dietary sodium, controling your cholesterol, increasing your exercise, and limiting intake of non-steroidal anti-inflammatory drugs like Advil and Aleve and especially avoiding caffeine containing NSAIDs like Excedrin.

You might also want to visit Kidney School to learn more about kidney disease and lab tests:
http://www.kidneyschool.org

[meldanad]

Thank you so much for your very helpful information and advice. I have been taking blood pressure tablets for about five years and these have obviously kept my blood pressure under control. However due to the fact that I had a persistent cough which my doctor said was a side effect of Perindropril - the tablet I was on at that time, it was changed to Atenolol and then to Irbesartan which I am taking at the moment. My doctor has told me that my blood pressure is now excellent. I had to have blood tests with each change of tablet, the last one being only last year. The result of these tests were fine as I was not recalled so it seems strange that within the space of twelve months my kidney function has deteriorated to only 50%. I cannot understand this. My doctor has said I now need to be monitored regularly but I will take your advice and ask to be referred to a kidney specialist. Thank you once again for all your help.