All that I can add is this: Ask. Ask questions of every doc, every nurse, every tech, every patient that you run into. You'll probably get some conflicting opinions, but listen to them anyway. Remember that no two patients are the same.
And if anyone, especially a physician, gives you that old, "Oh don't worry about that; let ME worry about it" answer, then report that to the head of the practice or group. That's a 1950's mentality, and shouldn't exist these days.
Carry a pocket notepad with you if you need to, or a iPod or cellphone. Record what is said so that you can replay it when you're relaxed and receptive.View Thread
Assuming that the radiologist is talking about "bloodflow" rather than "urine flow" (it would depend on the context of the entire report, and the type of test that was done, for example CT scan or doppler ultrasound.
Let's assume that it's bloodflow: they are looking at the volume of blood and the velocities as the blood passes through the kidney. Bloodflow affects renal function.
This probably isn't really relevant to the nephrectomy. But radiologists report EVERYTHING that they see. Determinations of importance, and diagnoses are left up to the doc who ordered the test. Radiologists don't diagnose, they just report the facts.View Thread
Ask the doc why they want you to travel the extra distance. I think that convenience is a pretty good reason to choose one over the other, you have to get there and home 3 times a week.
But there might be a medical reason. Somewhere on the Medicare pages there is a ranking of centers that covers things like anemia management, access management, rtes of adverse events, etc. If I can find it later I will post the link.
Unfortunately, the cynic in me suspects that there might be another reason that the nephs want you to go to one center over another: Dialysis in a HUGE moneymaker, and a lot of physicians have a financial interest in one or more centers. I hope that isn't a reason, but you have to wonder.
Fresenius is an equipment manufacturer, so they operate a LOT of dialysis centers. There are a few competing companies, but most of them are owned or managed by Fresenius. (It's interesting how incestuous all these medical/financial relationships get, isn't it?)View Thread
We have to be careful in self-interpretation of lab values, without the aid of a physician.
In this case we are talking about two very different things:
Creatinie and estimated GFR are blood-test vales. The /hpf is a urine test for bacterial infections. (HPF stands of "high power field", referring to a microscope view of bacterial white blood cells in urine.) 4/hpf might indicate a possible infection, 10/hpf or higher is a sure sign of urinary infection. This number can go as high as hundreds. But 0/hpf indicates no infection.View Thread
First; don't panic. A shift from 1.9 to 2.0 to 2.2 is not all that unusual. (I've been getting bloodwork done monthly for more than 15 years, and my serum creatinine has jumped around from 0.9 to 1.8 mg/dl. Most of the values range between 1.0 and 1.4 for me.)
Dehydration is probably one of the major factors in your case. You mentioned that they loaded you up with fluids and advise staying well-hydrated.
I'm guessing that your potassium was probably low, since they gave a potassium-sparing diuretic, rather than something like hydrochlorothiazide or lasix.
Reduced hemoglobin/hematocrit may be another factor in reducing renal clearance (because of the associated reduction in oxygen carrying capacity of blood.)
Ithink that the nurses or techs or docs gave you a somewhat over-simplified scenario when they said that levels should 'come down and not go back up'. That's just not accurate in every case.
I also suspect that there might be a big nutritional component to this: heavy drinkers often develop rather serious nutritional deficiencies, and dehydration and electrolyte imbalances frequently come in the package.
So wait for your GP, but try not to go overboard with worry. The stress will not help anything at all. Do stay hydrated even if you think you see some fluid retention. Fluid balance can't be fixed in a day or two, it takes a while to level out. If you see swelling in the ankles or wrists, then call the GP, and cut back very slightly on fluids and salt, but don't do anything drastic. Do not over-react. Try to eat properly.View Thread
It's hard to say, with the information given. There is a fairly broad range of "normal" kidney size. It varies a lot with age (which we know), body mass, gender, and the presence of conditions like hypertension and diabetes (none of which are specified). The apparent size on ultrasound could be slightly inaccurate depending on what the U/S weas TRYING to see; they can focus at different depths or from different angles depending on what the suspect might be going on. Things image differently from different angles or with different transducers on the machine.
If it was a Doppler U/S, then the might have a good idea of bloodflow through the kidneys. Blood flow, or lack of it, is the biggest single factor governing kidney health, regardless of the cause.
Right is almost always smaller then left, a function of the size of the liver in the abdomen.
Cortical thickness of 4.5 is the mean in one study (Buchholz, et al) which is very close to your result, while he found lengths around 10.4 as compared to your result of 8.3.
My initial guess would be that this is a normal anatomical wariation, unless there is some condition that you didn't mention.
The fact that the radiologist just reported the size, and not an atrophied appearance, and did not mention any bloodflow oddities makes me think that the size is insignificant to health.
Ask your doc for a detailed interpretation of the report, or provide a few more detail, if you have them handy.View Thread
During childhood development, the kidneys change position quite a bit as the body grows. Hydronephrosis is seen very frequently in young kids. I'm not quite sure how common it is in 11-12 year olds; by that age the overall growth and the relocation of the kidneys and ureters tends to be sorting itself out. But it is one thing to consider.
You might want to consult a pediatric urologist. (There is such a specialty, since the urinary system of kids is a lot different from that of adults.)
I certainly would not rush into surgery at this point, but a less invasive and temporary procedure like stenting might be an option.Or just waiting a couple of years might be an option, as long as the pain is not too disabling and repeted infections are not showing up.View Thread
The problem with salt and water and dialysis is that nothing reacts as it would with functioning kidneys.
Yes, it's true that in most people consuming more water will wash out some sodium. But if the kidneys aren't getting rid of fluid normally, then the aren't getting rid of sodium either.
DO NOT BECOME FIXATED ON eGFR! 3 points is nothing on that scale. It doesn't show a great improvement, and it doesn't show a great decline.
Dialysis patients need to watch fluid weight gain as much as they need to watch eGFR. The dialysis nurses should have given you a target for weight change fro(dry weight) to the weigh-in before the next treatment. If weight gain is approaching 5% of total body weight, something is wrong. I was also given a target for fluid consumption per day.
If he's way over the ideal dry weight, it can take a while to sort out. (We're about to get into the difference between intra-cellular and extra-cellular fluid, but that get's too complex for a forum like this.)
At the basis of all this is the fact that pitting edema needs attention, and that you probably need to cut both sodium and water intake. But you really need a physician's specific advice.View Thread