Need some help.

[blizzard2014]

I was wondering if anyone knows if Lisinopril can lower EGFR? I have a weird blood pressure problem in that my blood pressure goes very high only when I am standing up and walking around. Without meds it can go as high as 170/120 and is normally 140/110. But when I am seated, it can be absolutely normal. Sometimes I have to keep on re-adjusting my meds because it will lower my BP too low when sitting down. I recently had to go down to 10 mgs because my BP was going to 90/70. I was on 20 mgs before that for a while.

The second thing that has happened to me is that my EGFR has gone from 99 percent two years ago down to 75 currently. I had a 2 week period of vomiting and not being able to hold down any food or water last year when my Gallbladder started to go out on me. When I was admitted into the hospital, my EGFR was 32 percent. It started to recover after I had my GB removed and they pumped me full of fluids. It went up to 75 last year when I was released from the hospital and it is still 75 today.

I also have Type 2 diabetes and have a 5.4 A1C, but I have a terrible diet and still have some BS spikes. I use metformin and insulin to control BS spikes. I eat one meal every 24 hours and only use fast acting insulin once a day to get BS under control within 3 hours of that meal. I have fasting sugars up to 150. Sometimes I correct them with insulin, but I've been ignoring them for a few weeks. Do you think I should be concerned about CKD? My doc says those numbers are fine.

[MAS_Nurse]

Hi blizzard2014,

Welcome to our community. You have asked a lot of questions which we may not be able to answer. Please bear in mind that this is a peer support group, and we do not give medical diagnosis or advice.

Have you been diagnosed with Chronic Kidney Disease? eGFR is not the only indicator of developing CKD, and other contributing factors need to be considered. eGFR is an estimate of GFR taking in factors such as age, sex, and other information and it does fluctuate. Please click on the link to more information from the Edinburgh Renal Unit:

1) Blood Test results: edren.org/ren/edren-info/bl...

2) Chronic kidney disease and its progression: edren.org/ren/edren-info/ck...

Kidney Research UK:

1. Chronic Kidney Disease - what it is:

kidneyresearchuk.org/health...

2. Stages of Chronic Kidney Disease (CKD) :

kidneyresearchuk.org/health...

3. Healthy Eating:

kidneyresearchuk.org/health...

4. Diabetes & kidney disease: kidneyresearchuk.org/condit...

In regards to your diabetes, you should be monitored by your healthcare professionals. I note that you live in the USA so I don't know what services they offer, but here in the UK diabetics are have regular monitoring clinics where they may see a specialist diabetic nurse or dietician, to discuss your medication, BMs and give diet and lifestyle advice. Your diet regime is not good, and just using medication to manage your blood sugars isn't good practice. Your diet could well affect your eGFR. Having uncontrolled blood pressure and diabetes increases your risk of damaging your kidneys and possibly developing CKD. So I suggest that you get professional medical help to get your lifestyle and medication regimen under control. It should not be up to you to titrate up and down your medication without a doctor's guidance.

I hope this helps to answer a few of your questions.

Best wishes,

MAS Nurse and Moderator

[RickHow]

Obviously the answer from the nurse is complete. About lisinopril my own experience is that I have been taking it for years. I am stage 3 CKD. The lisinopril has not raised or lowered my egfr by any measurable amount, as egfr fluctuates regardless. I posed the very question you ask to my kidney doctor and my gp. Both gave virtually the same response. Lisinopril is helpful to kidney filtration but that I am taking it to control bp. That having high bp is more harmful to the kidney than taking an ACE inhibitor, so the priority is to keep bp under control. Of course your bp will be higher standing, etc., as you say. But your numbers are too high. Talk to your doctor and get things under control. There are many bp meds that can be taken with lisinopril. I myself had to add amlodipine to my daily bp control, with the lisinopril (10mg lisinopril in the morning, 5mg amlodipine in the evening).

[blizzard2014 in reply to RickHow]

The problem I have is that my BP spikes when standing and then goes to normal when sitting down all day. So, if I get it to normal level standing, it goes too low sitting. I usually keep it at abut 120-130 over 90 when standing and it will be like 100 over 70 or so when sitting. I have a delicate balancing act to manage it. I wish it was simply high all of the time because it would be more predictable. I get a lot of erratic heart rate symbols and sometimes it takes a long time to get a reading. Sometimes I can't get a reading for 30 minutes and have to keep on trying. So, it could also be heart rate fluctuations causing the high numbers. But if I can repeat the BP reading three times high, I take that to be a valid reading. I don't know if any of you have heard of autonomic dysfunction and hyper-pots. That is what I suspect I have but need to have a tilt table test done to confirm. I never suspected anything until it became almost unbearable to remain standing. I was getting average BP readings of 150/113 and higher before I decided to talk to my doc about this. He just calls it Labile blood pressure due to mood or whatever else can elevate. He thinks it's stress. But my blood clotting disorder also goes along with Hyper-POTS and autonomic dysfunction. I was merely worried about my kidney function going down 20 percent in one year. A new symptom I have had for only six months now is dry eyes and a bone dry mouth. No matter how much water I drink, my mouth is completely bone dry. I've been on the same meds for years and the new symptom does not have anything to do with a med change. I don't want to complain too much to my doc because I already have so much going on. Any how, thanks for the advice everyone.

[RickHow in reply to blizzard2014]

My father had similar episodes like those you describe. His primary care doctor responded much like yours. Ultimately he saw a cardiologist. This was the perfect step. Through various medications (all common generic) he got the heart beat and blood pressure well under control. My father ultimately passed years later at 92. See a cardiologist. Based upon my fathers condition my primary care also suggested I should see a cardiologist to monitor me closely in case anything developed based upon my heredity. After years of struggling with my bp and especially my triglycerides this guy brought everything to normal. It was not instant but through trying difference BP and cholesterol medications until we got the perfect combination.

[WYOAnne]

Sounds like an issue that you seriously need to talk to your PCP about. High BP can cause more damage to your kidneys and your heart. Your BP should be normal whether you are sitting or standing.

[blizzard2014 in reply to WYOAnne]

I was worried about my kidneys and had another kidney function test done because I had a few days in a row where I felt almost as bad as I did the day I went to the ER and they found the 32 percent kidney function. That day and on the other days I could not even remain standing for 1 hour straight to do the easiest job I have on the weekend. It hurt everywhere like sore body from the flu and I was light headed. I had to sit down in my car a few times and then just decided to leave work early. I have buildings I am paid to clean and do not have a supervisor. I just drive to them and clean them a few times a week anytime after 5 PM. I did not clean as good as I normally do, but since no one complained, all was good. If no one complains, then you can skip some of the cleaning steps; although I only do this on really bad days. I did take the Kidney function test a few weeks after the second bad incident though, so maybe it would have been worse if the tests were taken on that day. I have had fluctuating BP for a long time. Even a pediatrician caught a glimpse of it when I was a kid because he checked my BP right after I was standing. Same thing used to happen when I would get annual physical examinations for my commercial drivers license. I think I have had this for a long time because I had to become a truck driver because it was becoming hard for me to do physical work. I also have a moderately enlarged heart from damage caused by extensive blood clots in my lungs 8 years ago. Tests show normal ejection fraction, but maybe it goes lower when I stand. I get oxygen drops into the low 90's during the six minute walking test. It dropped down to 91 and then went back up after we stopped for a bit. I supposedly have moderate COPD according to lung function tests and moderate sleep apnea all not treated. I'm claustrophobic and cannot use the full face mask. Can't use the smaller mask because my pressure setting is 24, the highest setting there is and it would not work with a nose mask. Too many issues and sometimes I just shut down and ignore them for months at a time. I quit the heart doc because he would not explain things to me and would only pop into the exam room for 1 minute. It's like he's running an assembly line over there. Thanks for the advice!

[WYOAnne in reply to blizzard2014]

None of us on this site are medical experts. We can only give advice as to our own experiences. You need to have a medical appt with your doctor and find out what is going on. I cannot give you advice.

[Bet117 in reply to WYOAnne]

WYOAnne,

I agree with you. At this time. Blizzard must make an appointment with their PCP to have this looked into to evaluate the situation and see that the medication and dosages are correct for them.

[Bet117 in reply to WYOAnne]

Absolutely!

[Bet117]

Blizzard,

I agree with WYOAnne; see your doctor and review your symptoms with them and let them evaluate this in their presence.

Lisinopril is one of the most commonly prescribed drugs for kidney protection in diabetics as well as for protein spilling and blood pressure, but it is not for everyone.

Only your doctor can assess whether it is meeting your medical needs. Check it out and allow yourself peace of mind.

Please reach out and let us know how you are doing.

B..

[Hopefultaw]

Did you say you only eat a single meal every 24 hours??

[Susieg1]

You need to eat more than once in 24 hours. Eat a Mediterranean diet. Then your blood sugar and all your electrolytes will have a chance to normalize. That will then give your body the nutrition it needs to function properly and many of these issues will improve.