My father has a distended abdomen, fatigue, and occasional breathlessness on walking. I have attached the reports of my father. We are quite concerned seeing his low eGFR (estimated glomerular filtration rate), pre-diabetes values, cholesterol, etc. Please guide us on the best course of action. Kindly review his report and give us a suitable treatment plan.
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I saw his reports (attachments removed to protect the patient’s identity). His liver function test, thyroid function test, and complete hemogram are all normal. There is a slight increase in his serum creatinine, and the rest of his kidney function test is within the normal range. The stages of kidney disease are based on GFR (glomerular filtration rate). GFR of 53.02 mL/min indicates stage three of CKD (chronic kidney disease). An increase in abdominal size could be due to edema.
At this stage, anemia, high blood pressure may occur. But fortunately, it is not the case with your father.
Kindly answer me the following;
1) What is his blood pressure?
2) Is there any urinary symptoms?
I would suggest you get a nephrologist appointment as he would appropriately guide you further. If possible, meet the dietitian for a healthy diet to control sugar and lipid levels.
I hope you will find this information helpful.
Thanks for the reply.
He is hypertensive and under regular medication. He cannot urinate freely.
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It is good that he is taking medications for his blood pressure. A decrease in the urine output occurs as a symptom of CKD. Since when is this symptom present?
Thanks for your reply.
As per the nephrologist, he has been given only urine-related medicines. He had been prescribed kidney medicines for fifteen days. He was further suggested for USG (ultrasonography) scrotum and advised to consult a urologist after seeing the report (attachments removed to protect patient's identity). On the advice of his internal medicine doctor, we did an Echo (echocardiogram), ECG (electrocardiogram), and chest x-ray. X-ray reports are attached. His ECG says unconfirmed diagnosis with QTc 488 (borderline QT interval), and Echo is mostly normal with diastolic relaxation abnormality grade 1. I am worried about chest x-ray, ECG, and USG scrotum. Please advise.
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Sorry for the late reply, sir.
How is your father? I hope he is in good health and the medicine prescribed by the nephrologist is working for him as well.
I read the reports (attachments removed to protect patient's identity) which you have attached.
Coming to your query:
• In the chest x-ray, there are increased bronchovascular markings. It could represent acute or chronic infection of the lung or the heart. Since the Echo of the heart is normal, it is unlikely to be due to the heart.
Does he have any history of smoking or chronic cough?
If there are any lung symptoms, this finding has to be correlated with the clinical picture.
• USG scrotum shows cyst 5mm in the left testis, grade 1 varicocele on the right side, and grade 2 varicocele on the left side.
If the patient is asymptomatic, no intervention would be required. However, I would recommend getting a surgical opinion for the same.
• QTc means corrected QT interval. Generally, for men, it should be <0.45s. You have mentioned 0.488s, which is long compared with the normal upper limit value. There are various causes like electrolyte abnormality, certain medications, etc.
Among all your queries, you should visit an internal medicine doctor to interpret the QTc value and know its likely cause.
I hope you find this helpful.
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