kidney

Question
I think I see protein in my urine. I'm type 2 diabetic and high blood pressure. I do have stage 3 ckd  my creatine level is 1.8 and  gfr is 34. is it possible the kidneys are getting worse. I'm trying real hard to keep my pressure down and diabetic. Sign SCARED


Answer
Hi Ramona,



Thanks for asking my help on "Allexperts".



Some of the guidelines for patients with CKD stage 3 are:



# Optimize BP (target less that 130/80 mmHg4) and diabetic management (Hemoglobin A1C less than 7%5)

# Use of ACEI/ARB usually with a loop diuretic like Furosemide

# Twice yearly assessment of creatinine, potassium, calcium, phosphate, albumin, iPTH, Hgb

# Evaluate anemia and treat if Hgb

# Treat hypocalcemia, hyperphosphatemia, increased iPTH with dietary phosphate restriction, phosphate binders, vitamin D

# Renal ultrasound if not previously done

# Assessing risk factors for progression and cardiovascular disease (glucose control, hyperlipidemia, smoking)?treat accordingly

# Avoidance of nephrotoxic medications including NSAIDs and radiocontrast

# Hepatitis B vaccination

# Avoidance of upper extremity needle sticks in the non-dominant arm (may be needed later for dialysis fistula)

# Dietary evaluation and advice from a dietician



Please discuss these points with your Nephrologist and don't hesitate to follow up with me if you have any more questions/doubts.



Sincerely,



Dr. Shah