How is cause of CKD determined?

[FlowerPreciousLover]

Diagnosed with pre-diabetes, chronic bronchitis and high blood pressure, I'm thinking my CKD might be due to many antibiotics and steroids used for frequent, past, long bouts of bronchitis. I take Amlodopine 5 mg for b.p. , which research seems to be ok for CKD stage 3. I will be asking pharmacist about scripts for chronic bronchitis.

[Hidden]

There are several ways to make a diagnosis for CKD. The doctor who made mine went by my GFR and Creatinine levels. As it was later that day I had an appointment with a nephrologist and he had sent me very extensive paperwork that gave a complete medical history, drug history and asked for copies of as many previous labs as I could provide. He also had scheduled me for an ultrasound of my kidneys. When he looked at all of the results he told me that I had developed CKD after being a T2D for 18 years. Even though the past 2 years from that time my diabetes was well under control by medication, diet, and exercise. My blood pressure was a secondary factor but it was somewhat under control, just not as well as he would have liked. He did mention that if I couldn't improve my numbers after going on a kidney-friendly meal plan and if I didn't continue to control my diabetes since the doctor earlier in the day had me stop all of the T2D medications, he might need to order a biopsy to confirm the diagnosis and to see if there was another issue at play.

Fortunately, I've been able to do all of those things. I stick to my meal plan and make simple, often temporary changes based on lab issues, control diabetes without medications, my last A1c was 5.2, and since May when I fired my cardiologist and began seeing a new one my blood pressure is under control. I take three medications for that and in the right dosages for me and I'm usually around 122/72. Except when I get my semi-annual checkups from the podiatrist (no diabetes surprises) whose staff use those useless wrist bp monitors.

For those with more serious forms of kidney disease, possibly an inherited type there may be additional methods for the doctor to make the call. I hope that helps.

[FlowerPreciousLover in reply to Hidden]

Thank you Mr Kidney. My pcp never mentioned my gfr of 54 being stage 3 ckd. It was the ultrasound for possible cause of continuing wt loss that reported indication of renal disease. Only after a ff-up visit and request for neph. did I learn from neph. that the gfr score was the primary indicator for my ckd. It took repeated requests to both docs for dietitian referral and appetite enhancer. Both are now on "probation" until my next visits and lab results.

My pcp just sends me to the lab for a cbc at each annual visit and my next is scheduled late this month. Thinking I'll call and ask for the urine/bloodwork Prior to office visit. Receipt of the lab rept. after the visit gives no opportunity for any face-to-face questions to doc. Worth a try, yes?

Big congrats on improving your condition with renal diet. Both my self-imposed pre-diabetes and ckd renal diets improved my A1c to normal and my GFR from 54 to 68. The dietician gave me a combined diet plan to follow which was wonderful. Until the diverticulitis and finding of kidney stones. Emphasis has been on non-inflammatory food diet changes with less attention to combined diet plan. No idea what my labs will show but for this month, I'm charting each food and paying attn. to eliminating those which might aggravate divert. and kid. stones.

Will also call the nutritionist to see if another dr. referral is required for a follow-up visit for ins. payment. Like you, I am willing to do whatever I can to prevent a biopsy and worse lab results.

[KidneyCoach NKF Ambassador in reply to Hidden]

I'm curious about your comment "those useless wrist bp monitors." Is this opinion based on personal experience or do you have literature that supports this. I am curious either way. Blessings

[Hidden in reply to KidneyCoach]

mayoclinic.org/diseases-con...

ahajournals.org/doi/pdf/10....

I've included the above two articles to satisfy your curiosity but I also used my own experiences which in my opinion prove the validity of the conclusions drawn from those articles. I'll even provide you with a more specific example. I had my annual Wellness Check on Thursday of last week. My BP at home was 118/68 (digital monitor on my upper arm), and yes, it had been recently checked for calibration in early December. Sixty minutes later I was in my podiatrist's office for the first of my semi-annual check-ups and they use the wrist monitor.

My BP was calculated at 158/86. Finally, that was not a one-off. For the three years, I've seen this podiatrist they have used the wrist monitor for the last two years. Prior to that, they used a pole-mounted, automated machine. Since their switch, my blood pressure has increased off their readings by 25-40 points (systolic) and a proportional increase in diastolic readings.

I hope that satisfies your curiosity.

[Whitetail66 in reply to Hidden]

I was also told by my PCP that the wrist BP monitors are inaccurate. I go to Marquette Dental School, and the first year I went, they used wrist cuff monitors. I told the student what my PCP said about their inaccuracy, and the next year, the school got rid of the wrist cuffs, and went to the traditional manual type.

[Hidden in reply to Whitetail66]

Actually, wrist monitors are accurate but they are measuring blood pressure at the wrist which is different than pressure measurements at the upper arm. Arteries in the wrist are smaller and the pressure is higher.

I have found that most medical practioners do not follow correct procedures when using either type. Have you ever had someone not be able to get your BP and then immediately start pumping up the cuff again or try several times in succession? The forearm should also be at heart level and the cuff must be the properly sized.

I rarely come across someone that does it correctly.

[Ziggydoodah in reply to Hidden]

I have a high pain threshold, however sometimes, im in agony, when some health professionals take my BP. When i have told them it isn't right and they need to stop. I get told its normal to feel discomfort!! Discomfort??? I feel as if they are cutting off the blood supply in my arm. Since being diagnosed with kidney disease, I have met some lovely staff and others, I wonder why they are in the professional and if they are even qualified 🙄🙄.

[Ziggydoodah in reply to Ziggydoodah]

oh god..just noticed this is an old thread!!! I apologise 😳😳😳

[WYOAnne NKF Ambassador]

If you have no underlying disease, like diabetes, mine was diagnosed by a kidney biopsy. One of my kidneys was smaller than the other, so they biopsied the bigger, healthier looking kidney

They had already done countless blood tests to rule out lupus and other autoimmune diseases. Also, since I was other wise healthy, also did an IVP kidney x-ray. That way they could rule out over antibiotic use and NSAIDS.

With the biopsy they determined I had FSGS - focal segmental glomerulus sclerosis . My kidneys were getting all scarred up inside. With further testing and medical history it was determine that my strep infection at age 9 followed by nephritis was now the cause of my CKD.

Just so you know, from my experience, steroids help by removing inflammation. That is why after my kidney transplant I was on prednisone (steroid) as one of my transplant drugs,

Uncontrolled high BP can definitely cause kidney damage however= CKD.

I would ask for a kidney biopsy. It might help you to determine the cause of your CCKD.

[FlowerPreciousLover in reply to WYOAnne]

WYOAnne, thanks for your response and for suggesting the kidney biopsy and IVP kidney X-ray. As a teacher, I had years of strep infections but once out-of-the-classroom, respiratory turned to frequent chronic bronchitis infections. As a result, I've taken tons of antibiotics and prednisone over the years. Nor more NSAIDS since ckd diag.

My pcp suggested the last 22 day round of prednisone might be the culprit for the continuing wt. loss. Good to learn that steroids can help remove inflammation but preventing infection is even better and more caution on my part with future scripts of either.

[rabbit01]

I am sure that my CKD was caused by antibiotics. I had a very bad chest infection as a child and was given strong antibiotics to clear it up over an extended period (several weeks) I think either the infection itself or the medication or a combination of the two caused some damage to my kidneys but this was never tested. Then when I was 48 years old I got another severe chest infection and was given antibiotics and steroids for 10 days. At the end of that 10 days my urine was foamy, I had a metallic taste in my mouth and I felt unwell. A blood test showed that my kidney function was 17% and from that point on it just declined to 7% and I started dialysis.

[FlowerPreciousLover in reply to rabbit01]

Oh, my goodness, rabbit, I am so sorry your kidney function decreased so dramatically from your use of antibiotics and steroids. Clueless about possible effects, I really think my extensive use of both over the years contributed greatly to my ckd diagnosis. I can only be even more grateful now that my kidney function is no worse than it is. My good wishes to you as you continue your best health possible while on dialysis.

[rabbit01 in reply to FlowerPreciousLover]

Well I hope you can keep stable for many more years to come. Keep learning about the condition and do all you can diet wise to protect your remaining function. In my experience the nephrologists I saw were hopeless so if you don't think you're in the best hands then please look around for a better one. I certainly wish I had of done.

[Bassetmommer NKF Ambassador]

Sometimes, there is no apparent reason for CKD. But there are multiple tests that can be done such as blood work up over an extended period of time. I had 24 hour urine catch test where I had to pee into a milk jug for 24 hours. I had that done three times. I had multiple CT scans done where they discovered the huge kidney stones. I never had a biopsy done because it was clear from the stones what the issue was.

But all these tests were done way later, after a lab came in with a very low GFR. I was being diagnosed with Psoriatic Arthritis and at the time, there was little known about the connection to CKD and PsA. This was over 15 years ago. Months after the lab draw ( this was before we patients could see then) my rheumatologist was going through the labs and noticed the very low GFR and recommended I see a nephrologist. At that point the damage had been done.

The underlying cause was never discussed with the doctors because no one wanted to admit that the issues were in part caused by prescribed medications. I had been prescribed a high dose of Advil for over a year and a half, and then once diagnosed with Psoriatic Arthritis, they added Methotrexate and Prednisone on top of it. My A1C went to 13 when it had been below 5 forever and I had been peeing blood for over six months. I told them about peeing the blood and even that was dismissed because I was on a blood thinner. It was a perfect storm.

Since I had at that point rebounded to stage 3, I only saw the Nephrologist's intern who was a jerk. He was more concerned with my weight and never talked about the connection to diabetes, high blood pressure or how diet could change things. I do not think back then they knew much about renal diet accept for dialysis. Actually the diet they recommended was more damaging. No one talked about the medications. It was not until more recent, like five years ago, that they realized that the PsA changes the acid level in your blood. My uric acid levels were through the roof. That is what caused the stones. Once that was under control, no more stones and much better labs. They never said to stop the Advil completely and so I was still taking it in a much lower dose and not as often. It was not until I went to stage four in 2017 that I actually saw the nephrologist who really helped. I am also on a better medications all kidney friendly and no Advil.

[FlowerPreciousLover]

Thank you so much, Bassetmommer for sharing your "best intended at the time but dreadful" experience. So regret it took you so long enduring the storm before eventual high uric acid levels brought you to more control and better labs.

I agree that docs seem reluctant to admit to unintentionally contributing to the problems through previous treatments. Self-stopping my pcp's diabetic prescription and use of ginger stopped my months long nausea and resulting wt loss. She, however, tended to think it was another doc's script for prolonged prednisone that caused the nausea.

After 4 visits, neither my pcp nor neph. have seemed at all concerned about my stage 3 renal scores.

And while I think both the tests mentioned by WYOAnne would provide more helpful information, I seriously doubt either my pcp or neph. would recommend them for me. I will ask both at next visits but unless I have fallen to stage 4, I doubt either will take my request very seriously.

Am so glad that some here have found a medical team who communicates with one another and includes the patient in their treatment plans.

I'm unsure about how to find new docs who are more kidney proactive but may soon be in the market.

[KidneyCoach NKF Ambassador]

What I find interesting now is how few aides, nurses and even doctors can use a standard pump up cuff with stethoscope. These tend to be far more accurate for the most part in my opinion. The powered arm cuffs are next and wrist cuffs are now popping up all over. Because I have chronic low bp they rarely register my pressures. Then the aides complain no bp or worse LIE and give some ridiculous number like 130's over 80's. Something I've not had in 15+ years. It's all personal experiences and what is normal for you. I used to use an arm cuff attached to my dialysis machine which was set to take my bp every 30 minutes for 8 hrs. Late 2018 we switched over to a battery or AC/DC powered arm cuff. With varying degrees of issues we went with a wrist cuff. We attempt one reading with each device twice per treatment now. My individual issue with bp machines (not hand pumped) are because I've had 14 vascular surgeries causing undetectable bps. Manual ones using a living person who is dedicated usually produces a somewhat accurate result.

Thanks for your responses. I'm always curious about others' opinions and experiences.

Blessings

[jcwalker]

😍

[jcwalker]

I am a Jesus lover...He overcame my health issues...my goal is to walk in faith!