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Dr. SH
Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8753
Experience:  Doctor of Medicine
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My son who is now 16 is more aware now of the medical issues

Resolved Question:

my son who is now 16 is more aware now of the medical issues associated with hos kidney condition ckd3b/4boarderline, and he is clinically well. He struggles to cope with it. At his last clinic he asked alot of questions to understand the implication and what to expect. His consultant responses was concerning to me. for example my son aske at what level of creatine would he have to consider dialysis or transplant. His responses at first was to ask my son what level he would think this would be necessary to which he replied 300. Then he gave a very wide range up to 1000 andif he remains clinically well he would not need either. Does this make sense or just an inrresponsible response due to his age? I found the rest of the session very disappointingly unhelpful. My son is so full of life so blessed with talents and want to do so much, but seem somewhat disillusioned about alot of things right now. How can I help him? Can he see a different neprologist?
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. SH replied 8 months ago.

Thank you for your question.

Would you like to talk to me here or would you like me to call you to discuss over the phone.

Please let me know.

Regards

Customer: replied 8 months ago.

My be after your initial response pkease.

Expert:  Dr. SH replied 8 months ago.

Thank you for your response.

Can you please let me know exactly what his level of creatinine and eGFR is at the moment.

If you have blood reports with you at the moment can you please send them to me.

Thank you

Customer: replied 8 months ago.

Results from last clinic attendance on 12 April as below. he attends clinic every6 weeks now

- Creatine 232umol/l and marked high previous result was 226 and before was 215 and before that was 199. which was why my son asked the question.

- eGFR is not given on the report

- Urea 14.6mmol/l and marked high before was 12 and previous was 10

- Calcium 2.24mmol/l and marked low for the first time

- PTH 16.5 and marked high

Regards

Expert:  Dr. SH replied 8 months ago.

Thank you for your response.

The creatinine certainly is on the higher side.

There is no specific level of creatinine where we say that a person is supposed to be dialysed.

It all depends on the level of acidosis, whether there is presence of pericardial friction rub suggesting pericarditis (pericardium is the covering of the heart), the pace with which creatinine rises (in acute kidney failure a rise of creatinine from normal to 200 may be an indication for dialysis whereas in chronic kidney disease this is not the case).

These are just the few factors to consider.

So all factors need to be taken into consideration before commencing dialysis.

It is usually when the eGFR drops to less than 15 (end stage kidney disease) is when dialysis is started.

So, more than the level of creatinine, it is the level of eGFR that matters.

Stage 3b usually means an eGFR of 30-44. So there is still a long way to go before we even consider dialysis.

This session is open for any further questions that you may have.
I would appreciate it if you rate me by clicking on one of the rating options at your end on the top right hand corner as that is the only way we, the experts, are credited on here for helping you out.
Kindest regards

Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8753
Experience: Doctor of Medicine
Dr. SH and 2 other Medical Specialists are ready to help you
Customer: replied 8 months ago.

Many thanks for this.

Cow do you measure for acidosis?

What does this mean- is that poisioning?

what test should he be having to check for this and pericarditis?

What is PTH mesurement for? and how significant is it?

Regards

Lola

Expert:  Dr. SH replied 8 months ago.

Thank you for your response.

Acidosis is measured by a simple blood test that measures the blood bicarbonate levels. I am sure his will be fine because if he had acidosis he would have had breathing problems that would be pretty obvious.

Acidosis means that the kidneys are not being able to flush out acid from the body so the acid in the blood vessels increases which is what I am talking about.

PTH is a hormone that is increased when the blood levels of calcium are low or magnesium are low or both are low.

To compensate for the low levels of calcium the PTH increases.

Low calcium is very common in kidney problems and the PTH is compensating for that which is why the calcium level is in the normal range.

I would however like that he should be on a calcium and magnesium supplement as this will bring the PTH down.

High PTH for a longer period of time can weaken bones because PTH takes calcium out of the bone and adds it to the bloodstream.

Let me know if you have more questions.

Rate me by clicking on one of the rating options.

Regards

Customer: replied 7 months ago.

Sorry for delay in reply as I was away. I wanted to ask if my son could use calcium and magnesium supplement bought off the counter for this or should he ask for a prescription for specialized supplement due to his CKD?

Expert:  Dr. SH replied 7 months ago.

Yes he can take the OTC ones.

Customer: replied 7 months ago.

Thank you.

sorry for delay. It has been difficult to assess your website these days.

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