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.