Doctors' Answers to "Frequently Asked Questions" - Kidney Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Could These Recent Kidney Problems be Due to Ibubrofen [posted 12/02/98]
Question:  I have taken large doses of ibuprofen over a rather long period of time for a chronic pain condition.. (approximately 6 years, at least 1000-3200mg. per day. The dosages have tapered off, due to gastric distress, though not completely. However, I am experiencing some problems with fluid retention and experience some sharp thought intermittent pain in the kidney region. Urine has been extremely concentrated, though large amounts of fluids (water and herb teas) have been taken. What are the symptoms of renal damage from ibuprofen. Would a CBC test identify any problems? How would I know if damage has been done to kidneys.

Answer: Renal damage done by the  NSAIDS is usually painless and occurs slowly over 10-20 years. I would look for other causes of your problem.

Microhematuria [posted 11/11/98]
Question: After having had microhematuria for almost 9 years (and which was untreated), I had to go to the physician for something which was at first diagnosed as urinary infection (because of the sympotms of frequency, bouts of chill, and, of course, blood in the urine). As the medicine I was given, Trimethoprime 160mg x 2 for 7 days, did not work, I was given Amoxicillin 500mg x 3 for 10 days, then again Cyproxin 500mg x 2 for 5 days, and then, with the suspicion of prostate infection, Abboticin (Eryhromycin) 500mg x 4 for 4 weeks (which I quit after 3 weeks), then Tarivid  (Ofloxacin) 200mg x 2 for 7 weeks (which I quit after 3 weeks), then Azitromax (Azitromycin) 500mg x 1 for 7 days (which I quit after 4 days). None of these medications seemed the right kind of medicine. (Medicines given by different doctors.) And this has lasted for the 4 past months. During this time I have, naturally, taken some tests: Urography with sonography, Ultrasonic of prostate, Cystoscopy, PSA, and all the usual blood and urine tests in such conditions. All these tests have been normal, the sole finding being again blood in urine (6-8 red). Now after 4 months I am still having the symptoms- while I have never been as bad as I first was: chill, irritation and pain in the bladder-region, irritation in the urters, pain and discomfort on semen-discharge, and general weekness and illness of the body. It is important to add that these problems come intermittently, in intervals (mostly in the evenings after a day's work), and there are times, as brief as some hours, and, occasionally, as long as some days, which I feel I am getting well again (am almost syptom-free). But the symptoms do return. I have no pain on urine-discharge and I do not get up during the night to go to the bathroom. What can be the cause of microhematuria without infection? Several doctors which I have visited despair now of other solutions. May you please help me and tell me what is the next step for me to take. What shall I do now?

Answer: Well, I would see a nephrologist to see if the blood is from the kidney. This would usually require a kidney biopsy. However, this would be unlikely to cause any problems with urination, semen etc. Has a culture been done of prostatic fluid? What is the result ? Some organisms need high doses of particular antibiotics, usually dictated by culture. An Infectious Disease specialist would be my next choice if the nephrologist comes up empty.

Interstitial Cystitis [posted 11/11/98]
Question: I have interstitial Cystitis. I am in a geat deal of pain all the time on a scale of 1 to 10 most of the time it is 10. I have been to a urologist and they have given me DMSO treatments and I had a bladder distention nothing seems to work. They will only give me darvocete for the pain and diazepam 5 mg at night. but wll only let me stay on the diazepam for 2 months at a time. And the davocete does not give me much relief. When I had the bladder distention they gave me percoete that seems to help. I have bad insomnia because of the frequent urination is there something they can give me to sleep that I can stay on all the time? I had bad insomnia before this bladder problem. I am exhausted all the time and many days can barely function. They had given me hydrocodone but that mad me itch very bad. What doctor can give me different medications for these problems. I sure need to get some sleep.I think if I could get some sleep and some pain relief my life would be 100% better. Thanks again.

Answer: Try melatonin and if that doesn't work Benadryl 50 mg an hour before bedtime. Occasional patients will experience urinary retention symptoms with Benadryl so watch out;but, non-addicting.

Effects of Serzone & Lortab on the Kidneys [posted 10/22/98]
Question: Can you tell me if Serzone affects the kidneys? I have been on it for about 6 months and have bad lower back pain plus stomach pain on left side when urinating. I am also taking Lortab for the back pain. Could this combination make it worse?

Answer: Shouldn't be a problem, check for a stone or obstruction.

Kidney Pain [posted 8/13/98]
Question: Four years ago, I had surgery for a ureter blockage. I was told that I was probably born with it, but I went 19 years without any symptoms. I was at my doctor's office for a rountine exam when he noticed that my blood pressure was abnormally high and then the problem was found a few weeks later. For years prior to the surgery, I seemed to have lower right back pain. A few months before my problem was detected, the pain became worse and radiated to my lower abdomen. I had always attributed this to muscular problems. Shortly before my surgery, I asked my doctor if the pain could be associated with the ureter problem. He said there was no real way to tell, but if the pain stopped after the surgery, then it must be the ureter. If not, then it had to be attributed to some other problem. I have been withouth pain for 4 years, but have had symptoms recently. Is it at all possible that the ureter is obstructed again? Can it be from the damage that my kidney substained from the years of having the problem(the lower quadrant of my right kidney is non-functional due to the fact that I had the ureter problem from birth)? I am a very active person and it would not be entirely impossible for it to be muscle related, but I am very worried given my past history.

Answer: A blocked ureter will often produce the pain distribution that you are describing. With any onset, I would recommend an evaluation to ensure that your ureter is open and not fibrosing with scar tissue or progression of your basic problem. However, be aware that if it were to stop functioning completely that one only needs 1/4 of one kidney to avoid kidney failure.

Kidney Pain [posted 8/13/98]
Question: I have been having a problem with mainly my right and sometimes my left kidney. The pain has been around for several months and seems to be getting worse. It seems to only bother me in the early mornings after sleeping. The pain is worse the harder the surface that I sleep on. I am 33 years old and believe to be in good health.

Answer: Probably related to muscle cramps/spasm and not your kidney, but you will need a urine analysis as well as a back exam. You might be able to avoid this by changing/increasing the firmness of your mattress. This is most easily accomplished by putting 1/2 inch or 3/4 inch plywood sheet between the box springs and mattress and see if it changes. If so, it is clearly mechanical and your back.

Kidney Failure/ESRD [posted 8/12/98]
Question: How long can a person live on dialysis? What is the life expectancy of patients diagnosed with End Stage Renal Disease?

Answer: This varies a lot from patient to patient depending on the cause for the renal failure and their underlying health. For example, end stage diabetics commonly have strokes, heart attacks, etc., which reduces their survival on dialysis. Patients with isolated renal failure with underlying systemic disease (especially if younger) do much better. Ten years is a long time, but not unheard of and many will go 15-20, although uncommon. Renal transplant also affects this survival curve.

Kidney Stone [posted 7/16/98]
Question: I have had a stent inserted to help move a large stone over 5 weeks ago. Is it normal to have increasing amounts of blood and small pinhead-sized clots in my urine?

Answer: The bleeding will likely last as long as the stent is in place. This is a foreign body which is used to keep the ureter open, trauma from the stent and/or the stone is responsible for the micro bleeding, which normal and usually unavoidable.

Kidney Stones
Question: I am a 65 year old male. Within the last 3 weeks I had kidney stones in each kidney , at separate times. The right side stone passed in about 5 hours without hospitalization. The left side was more severe, first being confirmed when passing dark brown urine one time. However, pain continued and the emergency room treatment with painkillers in a drip eliminated the pain. IVP indicated presence of stone and drainage of both kidneys to be no problem. They strained urine and collected several small specks that will be sent in for testing. These are the only attacks that I have had in 37 years when a stone was removed by surgical means. Prior to that I had two other attacks that occurred two to three years earlier and both passed with much pain all occurring in left kidney. About one year ago I went on 10 mg of Vasotec, which is working well to control blood pressure. About 3 months ago I was placed on 50 mg of Precose to improve my blood sugar. Can either of these drugs cause my new kidney stone problems? It seems strange that stopping all consumption of sweets, beer, deserts etc., and starting these drugs seem to coincide with the reoccurrence of kidney stone attacks after 37 years with out any kidney problems.

Answer: Kidney stones are caused by hypersaturated urine causing crystals to form in the kidney. Once the original crystal forms, growth of the "stone" is easier than the original formation. This whole process can be prevented by keeping the urine dilute. This is the basis for recommending high water intakes to stone forming patients. Diabetes mellitus is notorious for keeping patients dehydrated. This occurs as glucose draws free water out the kidney. Initially this produces dilute urine, but as dehydration occurs more and more concentrated urine occurs. Prevention of your stones can be achieved by drinking more free water and avoiding high glucose levels. Vasotec and precose should have no appreciable effects.

Kidney Transplant
Question: Is there any way to "register" at several different hospitals for a transplant? I am already registered at one hospital.

Answer: There is supposedly a national match once you enter one program. You should ensure that your hospital cooperates in this program. If so, you're entered.

Water pills
Question: My husband read that there was some kind of link between kidney damage and the use of water pills. Is there a link between the two? How can we find more information about kidney damage?

Answer: There doesn’t appear to be any special link between diuretics and renal damage. It is true that many people who take diuretics suffer renal insufficiency, but this is most likely due to their underlying hypertension (the reason usually for a diuretic) not the diuretic.

IGA Nephropathy
Question: I'm seeing a kidney specialist in Seattle and he says I have a kidney disease called IGA nephrology. I have looked up several books and none of them reference this disease. I think I have Bright’s disease marked by blood and protein in my urine. I'm really into bodybuilding and need help with a few questions. Are anabolic steroids bad for my kidneys, and if so, why? Are certain anabolics worse then others? How does one get Bright’s kidney disease? Once you have Bright’s disease does it get worse, stay the same, or get better? What are my options for treatment?

Answer: Bright's Disease is an old term used to describe kidney disease 40-50 years ago. This is not a term that is currently used due to its lack of specificity. IGA nephropathy is well described and probably is the cause of your renal problems.

Steroids are widely used illicitly for developing muscle growth and strength. Many weight lifters and different athletes use these banned substances to enhance their performance. However, use of these drugs for this purpose is illegal for several reasons. The improvement in performance only lasts while the steroids are being used. Discontinuance will result in pre-existing strength and performance levels. These drugs have potentially severe long and short term side effects. It takes a professional knowledgeable in these side effects to monitor liver function and other potential problems. These include liver toxicity, edema or fluid retention, liver cancer, markedly elevated blood counts leading to strokes and thrombosis(clots), and an increase in risk of prostate cancer. Also, feminization can occur. This is an unfortunate side effect which is irreversible. It produces breast development and shrinkage of the size of the testes.

Although I am aware that many individuals use these substances the benefits really don't outweigh the risks in my opinion. I would strongly advise that your physician at least monitor you if you decide to use these substances-they are not simple nor risk tree. I would strongly recommend that you avoid these substances with your kidney problems.

Dialysis
Question: A friend of mine, 73 yrs old, got kidney damage from some kind of heart medication, he is now on kidney dialysis every second day. He was also on a diuretic for several months, another doctor took him off the diuretic and told him he shouldn’t have been on this drug, ever. This man has about 5% of his kidneys functional, he noticed that since he stopped using the diuretic he now has some pressure when he urinates, which he didn’t have before going off the diuretic, which to him seemed to be an improvement. My question is this, do you think there is a chance his kidneys can somewhat rejuvenate so he doesn’t have to be on the dialysis machine so often?

Answer: Some types of renal insufficiency are reversible-some are not. I suspect he has both a fixed and a reversible component. Most drugs do not last in terms of toxicity -but, there are exceptions. Usually when you get below 10% or so you'll wind up on dialysis. Only time will tell, but, he may get better kidney function over 6 months.

Peritoneal Dialysis
Question: I am a peritoneal dialysis patient. (11 years) I have been experiencing extreme itching due to high phosphorous levels. It is not accompanied by a rash. It feels like the itching is inside. Topical treatments do not work. What can be done to relieve this? I am extremely careful with my diet, etc hence, I have managed to live 11 years on CAPD.

Answer: Most patients on dialysis will take oral phosphate binders to help this problem. Has this been suggested by your physician?

Unknown Mass
Question: I had a ct scan and it showed a mass on top of the right kidney. There is an irregularly enhancing mass at the right upper renal pole as described above with amputation of the right upper pole calyceal system and a small fleck of internal calcification. The findings are highly suspicious for a right upper pole renal carcinoma.

Answer: Suspicious for certain- you need surgery or a biopsy.



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