Kidney Function: Key Concerns and Management Strategies - Internal Medicine

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Renal function index


Hello Dr.
Yang,
Due to having urinary tract stones in my youth, I have not noticed for a long time that my left kidney has become swollen.
My creatinine level is currently 1.5, and my urine protein level is about 190, for which I am taking medication for control.
I would like to ask Dr.
Yang:
1.
Is a creatinine level of 1.5 considered too high?
2.
Does long-term use of medication to control urine protein have any impact on kidney function?
3.
Given that my uric acid level is relatively high at about 9.5, will long-term use of uric acid-lowering medication affect kidney function?
4.
As I age, will my kidney function deteriorate further?
5.
What dietary and lifestyle precautions should I take to prevent further deterioration of kidney function?
Thank you,
Respectfully,
8:31 AM, 10:55 AM

Ala, 60~69 year old female. Ask Date: 2004/08/31

Dr. Yang Jun reply Internal Medicine


Hello: In response to your question, the presence of protein in urine and a creatinine level greater than 1.4 are indicators of impaired kidney function, which must be managed under the guidance of a nephrologist regarding medication and dietary treatment.
Kidney function may decline slightly with age, but this typically does not affect overall health.
Prolonged high uric acid levels can lead to gout or kidney stones, which can impact kidney function; however, medications to lower uric acid do not affect kidney function but may have an impact on liver function, so caution is advised.
In cases of declining kidney function, it is important to maintain a low-sodium, low-protein diet, avoid high blood pressure and high blood sugar, refrain from smoking, and follow dietary guidance from a nutritionist along with regular outpatient follow-ups and medication adherence.

Reply Date: 2004/08/31

More Info


Understanding kidney function is crucial for maintaining overall health, especially for individuals with a history of kidney issues or other related conditions. In your case, the presence of hydronephrosis due to a history of ureteral stones, along with elevated creatinine levels and proteinuria, indicates that your kidneys are under stress and may not be functioning optimally. Let’s address your concerns one by one.

1. Is a creatinine level of 1.5 too high?
A creatinine level of 1.5 mg/dL is indeed above the normal range, which typically falls between 0.6 to 1.2 mg/dL for most adults. This elevation suggests that your kidneys are not filtering waste products effectively. It’s important to monitor this level regularly, as persistent elevations can indicate chronic kidney disease (CKD). Given your history of hydronephrosis and proteinuria, it would be wise to follow up with your healthcare provider to assess the underlying causes and consider further evaluation.

2. Does long-term use of medication to control proteinuria affect kidney function?
Medications prescribed to manage proteinuria, such as ACE inhibitors or ARBs, can actually help protect kidney function in the long term, especially in patients with conditions like diabetes or hypertension. However, it’s essential to use these medications under the guidance of a nephrologist, as they can have side effects and may require monitoring of kidney function and electrolytes. Regular follow-ups will help ensure that the benefits outweigh any potential risks.

3. Will long-term use of uric acid-lowering medication affect kidney function?
Medications used to lower uric acid levels, such as allopurinol, are generally safe for the kidneys and can even be beneficial, particularly in preventing gout attacks and the formation of kidney stones. However, it’s crucial to monitor kidney function periodically, as any medication can have side effects. If you have a history of kidney stones, managing uric acid levels is important, but it should be done with regular medical supervision.

4. Does kidney function decline with age?
Yes, kidney function tends to decline with age. This is a normal part of aging, but the rate of decline can vary significantly among individuals. Factors such as pre-existing conditions (like hypertension or diabetes), lifestyle choices, and genetics can influence how quickly kidney function deteriorates. Regular check-ups and proactive management of any chronic conditions are essential to slow this decline.

5. What dietary and lifestyle changes should I consider to prevent further kidney deterioration?
To protect your kidney function, consider the following lifestyle and dietary modifications:
- Hydration: Ensure you are drinking enough fluids, as dehydration can worsen kidney function.

- Diet: Adopt a kidney-friendly diet that is low in sodium, phosphorus, and protein. Focus on fruits, vegetables, whole grains, and healthy fats. Limit processed foods and those high in salt and sugar.

- Blood Pressure and Blood Sugar Control: Keep your blood pressure and blood sugar levels within target ranges, as both can significantly impact kidney health.

- Avoid Nephrotoxic Substances: Stay away from over-the-counter pain medications like NSAIDs (e.g., ibuprofen) that can harm the kidneys, especially if used long-term.

- Regular Monitoring: Schedule regular check-ups with your healthcare provider to monitor kidney function and adjust your management plan as necessary.

In summary, while your current kidney function is a concern, with appropriate management and lifestyle changes, it is possible to stabilize and even improve your kidney health. Regular communication with your healthcare provider is key to navigating this journey effectively.

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