Heart attack, SODIUM DEFICIENCY with increased BLOOD UREA NITROGEN.

Hello.
Thank you for your query at DoctorSpring.com
I understand your concern.
Your father mostly seems to have Acute kidney injury. He being an aged person , is vulnerable for any kind of insult , however trivial it may be,and can get his creatinine elevated.
There are lots of other causes of high urea and creatinine values. So we need to carefully evaluate your father.
1) Dehydration and inadequate water intake is the commonest cause. Please ensure he is drinking 3-4 liters of water per day.
2) Urine infections, hematuria and proteinuria can also lead to increased creat levels.
3) Badly controlled hypertension can also lead to high creatinine.
4) Any recent thorat infections, or pneumonia can also aggravate the creatinine levels.
5) Certain drugs are also reno-toxic however the drugs you mentioned should not be causing toxicity to the kidney. All other factors such as dehydration, bad bp control has to be ruled out before attributing it to medicine toxicity.
What is his BP currently?
How is his urine output?
Is there any swelling around the eyes, feet, face (e.t.c )?
Is there any fever or loss of appetite?
Apart from the derangement in the kidney parameters, his lipid control also needs to be monitored since his triglycerides are on the higher side. That again can cause hypertension. Lasix and fruselac can cause occult ( unseen) dehydration which in the presence of losar can elevate the creatinine. Stopping them and hydrating him well can reduce the creatinine.
I will also advise a CT KUB to understand the extent of damage to the kidney, in case it is present.
Kindly reply to the above mentioned queries for me to be able to help you further,
Regards.

Sir,sorry for the later reply.Please find below my remarks
What is his BP currently? His BP is perfectly normal right from the episode of heart attack happened in the last year and with medicines.I do monitor it on regular basis How is his urine output? 10-12 times Is there any swelling around the eyes, feet, face (e.t.c )? some swelling i cud see on face but i m not sure Is there any fever or loss of appetite? No loss of apetite.Fever happened five days back but i think that was because of sore throat and hence we went to the doctor on 3rd Sep
I will also advise a CT KUB to understand the extent of damage to the kidney, in case it is present.We will do that on day after 2mrw for sure Sir,also doctor has suggested Augmentin650mg 5 days course for the sore throat along with Dolo which he has not taken because there was no fever and his sore throat was also better.Actually he is already very unhappy with so many medicines and hence avoided additional medicines
Sir,i also want to know why there has been reduction in creatinine levels within 3 days(from 1.9 on 3rd Sep to 1.6 on 7th Sep and since last year it was completely normal,what does it shows.
are there any other tests required or CT would be sufficient to understand the actual status of Kidneys.

Hello.
As i told you in my last reply, he is mostly having AKI ( Acute Kidney Injury ).
However there are some encouraging signs like his BP is normal. Also his urine output seems adequate. There is slighlt facial puffiness as you mentioned but we can wait and repeat his creatinine after 4 weeks and at that point we can review his status.
Now again reduction in creat levels is a good sign, and that indicates he is recovering. Ideally creat should be around 0.8-1. Hopefully with good hydration it will be fine in 4 week's time. CT KUB should be fine and once you have the reports you can upload it and i will review the case accordingly.
I will also advise you to talk to your local doctor who suggestes him Losar and Fruselac, and if his BP is under control then alteration in the dosage can be done. This will also help the kidney recover faster.
Hope this was helpful,
Regards.

Thanks Sir,I will update the reports by 10th Sep,2014 and I will also ask for the revision of the medicines!

Sure.
Upload the reports when they are ready.
Also let me know what your doctor says about alterations in the dosage.
Kind regards.

Dear Sir,
Please find attached the CT Scan for the Kidneys.Please guide accordingly.

Regards,
Shefali Chopra

Hello.
The CT scan has revealed that kidneys are small but its not surprising that his kidneys are a bit small and of borderline size.
He has a vulnerability for his creatinine to be elevated due to the size. However, you do not need to worry as he can be given good conservative treatment for the same with which he can maintain the kidney function he has now, for several years.

You can repeat the serum creatinine test in the first week of October. If it is more than 1.3 mg/dL, you need to consult a nephrologist in person who can examine him and evaluate the medications he is on and modify accordingly. For now, please make sure he remains adequately hydrated.

As for the diverticulosis seen in the scan, you can seek consultation of a Gastroenterologist.

Regards.