Dr. Manzoor Ahmad Parry
Nephrology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I would like to enquire about a 72-year-old male who is suffering from heart failure and kidney impairment. He is diagnosed with mild kidney impairment, despite normal urine output and no physical complications.
He is currently taking Cortrop 5 mg, Aspirin 100 mg, Lasix 120 mg, Zyloric 200 mg, Plavix 75 mg, Crestor 20 mg, Pantoprazole 20 mg, Isosorbide Dinitrate 10 mg, Hydralazine 25 mg, and Ferrinject 1000 mg injection (once). He also has done urea, uric acid, and creatine always fluctuate in all blood tests. The latest kidney function blood test is attached.
Hello,
Welcome to icliniq.com.
I read your query, before answering your query I would like to know about USG (ultrasound) of kidney and urine examination if done. What was KFT before this test?
His kidney impairment can be due to age-related or due to heart failure. That is why I want to know about USG and urine examination. Also, I would like to know whether the patient has any swelling of legs and nocturia symptoms?
Patient's Query
Thank you doctor,
If I understood your request correctly, I have attached the previous test results now for your reference. His cardiologist requested a consultation from a renal doctor in order to fix his kidney function numbers and was wondering if the patient needs vitamin D and calcium supplements in addition to Epo (Erythroprotein) to meet hemoglobin of over 10 g/dl. Kindly advise on the case.
Hello,
Welcome back to icliniq.com.
I have seen the reports (attachment removed to protect patient identity).
Regarding CKD (chronic kidney disease) as his creatinine has been high since 2014, our aim should be to prevent the worsening of KFT and treat the complications of CKD.
To prevent worsening of KFT, the patient needs to follow low-protein diet with control of BP (which in this case, I believe is in control) and avoid the use of any nephrotoxic drugs. The patient has been started on sodium bicarbonate but the dose should be 500 mg. He can be started on Alphaketo-analogue two tablets three times a day to compliment a low protein diet.
Regarding anemia, I do not know his Hb (hemoglobin) level (not provided with reports). He can be started on iron supplements plus Folic acid, vitamin B12 levels and Epo. Also do iron profile investigation.
Regarding vitamin D and calcium supplements, I would advise serum PTH (parathyroid hormone), Vitamin D levels and calcium, phosphorus, and ALP (alkaline phosphatase levels) and to be decided after these investigations.
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Nephrology
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