I'm a 26-year-old professional male; I have been diagnosed with a hypo plastic right kidney (with function ranging between some and non depending upon the physician). The other kidney is apparently fine, however form time to time I have pain in the good kidney, and as of late I have been having foamy urine (which indicates proteinuria), and have been urinting at night to the point of incontinence. I'm currently under treatment with a new Nephro, However I'm not too happy he seems to take a wait and see caviler approach. I have suggested that we run a renal function lab, and 24 hours urine w/albumin scan due to the presence of protein in my urine 2+ and 1+ respectively per my last lab results, however all he suggests is a spot urine collection with protein and creatinine concentration. My other lab values are as follows:
BP ranges from 130/85 (digital) to 110/80 (standard cuff)
PROTEIN TOTAL, QUAL 2+
BUN 16
BUN/CREAT RATIO 13.9
CREAT CLEARANCE 1.1
and
BP ranges from 130/85 (digital) to 110/80 (standard cuff)
PROTEIN TOTAL, QUAL 1+
BUN 16
BUN/CREAT RATIO 17.8
CREAT CLEARANCE 0.9
Now mind you the labs were taken with in one month of each other...
What are the major thoughts per the experts here...? Should an ACE inhibitor be prescribed...?, What about a 24/hr urine over a spot urine check, furthermore what about the albumin, why has he not checked it. To be honest I have seriously considered altering the order to include the extra tests (because I have asked several times for my piece of mind), however he still will not run them...? To make matters worse my cardio seems to think that I may have CHF, due to strange chest pain sensations (however this should have shown-up, per the multiple echo’s, and stress tests. My GF is a nurse and she is concerned via that fact that a problem may exist, and it would be better to stop it before it becomes worse. However, I’m wondering if he wants to prolong this, just in order to keep me coming back to him, I.E. every six months, and so on.
Sincerely,
Perplexed…?
Is this normal kidney function...? Help requested...
Moderator: administrator
HI there
I am going to go with your concerns simply because you have had some negligible amounts of protein in the urine and the excessive urinating at night. I too was pretty much where you are 9 years ago. I just had my kidney transplant last month. Although I am NOT saying this because I think that's where you are going.
You are obviously very well researched and versed on the lingo, the albumin, and having 24 hour urine collections as opposed to spot urine. After my experience, where the BUN, creatinine, and creatinine clearance were relatively within normal range, but there was 1+ and 2+ protein in the urine, I recall that the albumin values were off once it was checked, and that I needed to urinate copious amounts at night. My neph at the time also did not do 24 hour urine collections which the next neph sort of shook his head at.
In my experience, again, everyone is different, the protein was present in my urine and the albumin was off and i was slightly anemic (11.4) before anything else began to worsen (such as the BUN or creatinine). Which is my main reason for saying, either A) check off those boxes yourself to get the other things checked and hand in a 24-hour collection at the same time, or B) get yourself to a new neph.
I stayed within the range you are in for a long time. Six years without any real change. My bp was also fine. You are correct than an ACE inhibitor could help considerably. It has been known to take some of the work off of the kidney and preserve function. I took one for 9 years.
Because the function in your other kidney is lessened or obsolete, it's possible that is the reason for a higher urine protein content. However, I don't know much about the condition you say damaged the other kidney. I just remember getting different readings with the protein in my urine even days and weeks apart nevermind a month like yourself. It totally perplexed my neph at the time. The new one told me that it was pretty normal for kidney disease.
Have you had a biopsy? Where do you live, since I find such a lax attitude not necessarily odd, but if you are in the States I would find it more unusual than if you are abroad. Do you feel there is someone else you could go to to have your questions and tests done to your satisfaction?
My opinion is simply that you should always, always, always listen to your concerns. I put the "little voice" in my head away too many times. When it's there it means you are questioning and maybe onto something.
Keep us posted and ask away. This is a good place.
Also wanted to ask. Do you ever have any itching, swelling of the hands, feet, legs, how is your hemoglobin, tiredness, shortness of breath, headaches,. Early on I was just tired, but not always. And I had on and off itchiness, and bouts of swelling mostly in my legs, but sometimes in my abdomen as well. Protein loss can do this, although you are not really losing enough at this point to have edema. Just wondering.
Natalie
You are obviously very well researched and versed on the lingo, the albumin, and having 24 hour urine collections as opposed to spot urine. After my experience, where the BUN, creatinine, and creatinine clearance were relatively within normal range, but there was 1+ and 2+ protein in the urine, I recall that the albumin values were off once it was checked, and that I needed to urinate copious amounts at night. My neph at the time also did not do 24 hour urine collections which the next neph sort of shook his head at.
In my experience, again, everyone is different, the protein was present in my urine and the albumin was off and i was slightly anemic (11.4) before anything else began to worsen (such as the BUN or creatinine). Which is my main reason for saying, either A) check off those boxes yourself to get the other things checked and hand in a 24-hour collection at the same time, or B) get yourself to a new neph.
I stayed within the range you are in for a long time. Six years without any real change. My bp was also fine. You are correct than an ACE inhibitor could help considerably. It has been known to take some of the work off of the kidney and preserve function. I took one for 9 years.
Because the function in your other kidney is lessened or obsolete, it's possible that is the reason for a higher urine protein content. However, I don't know much about the condition you say damaged the other kidney. I just remember getting different readings with the protein in my urine even days and weeks apart nevermind a month like yourself. It totally perplexed my neph at the time. The new one told me that it was pretty normal for kidney disease.
Have you had a biopsy? Where do you live, since I find such a lax attitude not necessarily odd, but if you are in the States I would find it more unusual than if you are abroad. Do you feel there is someone else you could go to to have your questions and tests done to your satisfaction?
My opinion is simply that you should always, always, always listen to your concerns. I put the "little voice" in my head away too many times. When it's there it means you are questioning and maybe onto something.
Keep us posted and ask away. This is a good place.
Also wanted to ask. Do you ever have any itching, swelling of the hands, feet, legs, how is your hemoglobin, tiredness, shortness of breath, headaches,. Early on I was just tired, but not always. And I had on and off itchiness, and bouts of swelling mostly in my legs, but sometimes in my abdomen as well. Protein loss can do this, although you are not really losing enough at this point to have edema. Just wondering.
Natalie
Natalie,
Thank you for your response, I sincerely appreciate it. I think that I'm going to check off the box(es) and roll the dice ( I have nothing to loose, I can care less if the Dr is pissed, it's my life..., put himself in my shoes!). Unfortunately I'm located in Buffalo (Western New York), as a result we have very few Nephro's, and a large majority of which work out of the same office. As far as I read, protein should never enter the urine in any capacity, even in my case with the other kidney issue. As for other problems, I'm tired, however I can't say that I have any other problems other than at times spasm like feelings in the legs or ankles. I could see if my general pract. will do so, however per my last results with him, " I was fine". Honestly it scares me what you are stating, however I as well as “theyâ€
Thank you for your response, I sincerely appreciate it. I think that I'm going to check off the box(es) and roll the dice ( I have nothing to loose, I can care less if the Dr is pissed, it's my life..., put himself in my shoes!). Unfortunately I'm located in Buffalo (Western New York), as a result we have very few Nephro's, and a large majority of which work out of the same office. As far as I read, protein should never enter the urine in any capacity, even in my case with the other kidney issue. As for other problems, I'm tired, however I can't say that I have any other problems other than at times spasm like feelings in the legs or ankles. I could see if my general pract. will do so, however per my last results with him, " I was fine". Honestly it scares me what you are stating, however I as well as “theyâ€
Hello,
I was diagnosed at 32. My stats were a great deal worse than yours. BP 190/120. Creatanine 700 (Dont know how this translates from UK to US but pretty high).
My Doc put me on ACE and that was it. Even at this stage he said to wait and see. This drove me mad, every two weeks I would go back and he would do nothing, I asked him is he going to do anything at all? Like all drs his treatment was based on stats and he said when my creatanine reached 1000 then he would act!!
It was a very dark time and I guess like you I spent hours on the internet arming myself with information to challenge the dr with (still do, in fact). I dont really believe in the idea that `dr knows best`. But I could see that with my stats dialisis was inevitable. With you at an earlier stage there is maybe something that could be done, so yes time to be proactive!
PS. I have had the same nephro dr for four years and he is very good, seeing someone at least once a month you do tend to build up a relationship, asking about kids and so on. Maybe a second opinion rather than an axe waiting to fall?
PPS. Saying all that I was sorry when the createnine did go past a thousand as I then had to go on dialisis, after that there was no stopping him!
I was diagnosed at 32. My stats were a great deal worse than yours. BP 190/120. Creatanine 700 (Dont know how this translates from UK to US but pretty high).
My Doc put me on ACE and that was it. Even at this stage he said to wait and see. This drove me mad, every two weeks I would go back and he would do nothing, I asked him is he going to do anything at all? Like all drs his treatment was based on stats and he said when my creatanine reached 1000 then he would act!!
It was a very dark time and I guess like you I spent hours on the internet arming myself with information to challenge the dr with (still do, in fact). I dont really believe in the idea that `dr knows best`. But I could see that with my stats dialisis was inevitable. With you at an earlier stage there is maybe something that could be done, so yes time to be proactive!
PS. I have had the same nephro dr for four years and he is very good, seeing someone at least once a month you do tend to build up a relationship, asking about kids and so on. Maybe a second opinion rather than an axe waiting to fall?
PPS. Saying all that I was sorry when the createnine did go past a thousand as I then had to go on dialisis, after that there was no stopping him!
Jim
Buffaki
I am in NYC, and I want to share the clinic I went to. You'll see that there are many links on this site. The name of the clinic is Rogosin Institute.
http://www.rogosin.org/kidneyDisease.html
You can always google. com it for more information.
Would there ever be any way that you could come to NYC to see a doctor?
I would recommend that you do try first to get the complete bloodwork and urine collection done there. It's simply the fact that one of your kidneys is not working well that would concern me the most, and then the proteinurea.
What about the Mayo Clinic in Rochester, NY? Try to reasearch some places to see if there's somewhere else you could go that would feel more supportive. I wouldn't say you are at a point where you need monthly appts. but perhaps six months is a bit too long for the nerves to take?
I can eat what I want now that I am post-transplant.
And I don't even take a lot of medication. At one year, it will be two tablets in the am, and two at night.
Natalie
http://www.rogosin.org/kidneyDisease.html
You can always google. com it for more information.
Would there ever be any way that you could come to NYC to see a doctor?
I would recommend that you do try first to get the complete bloodwork and urine collection done there. It's simply the fact that one of your kidneys is not working well that would concern me the most, and then the proteinurea.
What about the Mayo Clinic in Rochester, NY? Try to reasearch some places to see if there's somewhere else you could go that would feel more supportive. I wouldn't say you are at a point where you need monthly appts. but perhaps six months is a bit too long for the nerves to take?
I can eat what I want now that I am post-transplant.
And I don't even take a lot of medication. At one year, it will be two tablets in the am, and two at night. Natalie
Re:Hypo plastic kidney
Hello I also have a hypo plastic right kidney but unfortunately everything except a normal ureter is missing from the left side which is why I started my dialysis journey at 6 years old. As far as I recall I also ahd protein in my urine and probably still do but my blood pressure has always been fine. I think you do need to see a different Neph or at least get a full evaluation of where you are in the function of your kidneys. There is no reason why the left can't do all the work but it depends whether this problem with the right kidney causes the left to be compromised in its function. I think you need if for nothing more than your own peace of mind some indication of what can be done, when and how.