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Old 04-24-2018, 11:28 PM
 
Location: Space Coast, FL
849 posts, read 219,734 times
Reputation: 670

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I got the results of my 90 year old's mom's latest blood work and according to the doctor and what I can discern from the numbers, her kidney function has decreased. Reason for the blood work was to check B level as she is so lethargic lately, thought that level may be low. Turns out it was just fine. He white blood count was 10.08 which the doctor didn't seemed concerned as only slightly elevated. And I just noticed MCHC was 30.09 in the low column. Doctor didn't mention that either, but it's on the printout.

Numbers that were all in the high column:
BUN - 53
Creatinine - 2.1
BUN/Creatinine ratio - 25
Glucose - 109
Osmolality -

It's the first two numbers that she circled.

For two years, this doctor has been telling her to drink more water. She refuses. And even if she started drinking the right amount now, unknown if it will do anything. Her comment was to pray. Next step dialysis, question as to when. Wants to see more blood work in 2 months.

I don't have copies of the records from when she was in the hospital in September so no comparison, but I assume everything was fine.

Can someone tell me what I am looking at realistically? Thank you,

Jules
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Old 04-25-2018, 01:47 AM
 
Location: Canada
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The normal creatinine range for adult females is 0.4 – 1.1. So I can see why the doctor is concerned.

Water helps to keep the kidneys flushed.

A kidney friendly diet is probably what your mother should be on too so her kidneys won’t have to work so hard. You can google the term for information.
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Old 04-25-2018, 07:42 AM
 
3,881 posts, read 10,168,768 times
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Does she just not like pure tap water? How about those slightly flavored waters? I love them and they are cheap. No bad additions just a taste of something like lemon or orange. How about green tea or herbal teas? She might enjoy a variety served in special china. I dont really know what has been tried but I dislike plain water and do love all the different things I can try.

There are even flavored sparkling waters if she likes that.
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Old 04-25-2018, 07:51 PM
 
Location: Fredericksburg, Va
5,343 posts, read 14,363,356 times
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Everyone, as they age, will have decreased kidney function. You can live quite well on 12-15% kidney function....hubby was ok until his got to 8%...then he started dialysis. Your mother is likely to NEVER need assistance in that way, at her age.
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Old 04-26-2018, 12:37 PM
 
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Agreed that just having decreased kidney function doesn't mean it's automatically dialysis. Basically when it becomes "end stage renal disease" - then it's dialysis. I don't have the lab #'s for the cutoffs, so have no idea where your mother is in that process.

Thank you google:

Chronic renal failure

According to link, just looking at Creatinine levels, she is still "Chronic Kidney Disease". Once the level gets above 3.0, progression to "End stage renal disease (ESRD)" or "Chronic Renal Failure (CRF)" is considered irreversible.

When it becomes ESRD/CRF - the option is dialysis/transplant or death.

My father is on dialysis (he's 90) -and has been on it for nearly a decade (in that respect, he is far from ordinary). He tolerates it very well, but my understanding is that it can be very hard on people. To be honest, if he were just now being diagnosed, etc.. I question whether we would start dialysis, or just accept that he has a fatal prognosis.

If your mother is otherwise hale/hearty, and it gets to the point that she needs dialysis -she may do fine. If not, then is it something that really should be pursued?

As far as dialysis itself - there's 2 types, one through the stomach (peritoneal) and the other through veins (possibly a graft) - hemodialysis.

In my father's case, it's hemodialysis. He had to have a graft created, as his own veins were not sufficient to handle the pressure created during dialysis. He goes 3 times a week, and is dialyzed for about 3 hours.

Some people suggest that peritoneal dialysis is gentler, but that seems to be done at home (with the family/aides assisting in the process) and I think for a lot of people the idea of that is very intimidating.

(Peritoneal was never offered as an option for my father, and I haven't currently pursued it).

Medicare pays for dialysis (I believe at 100% - dialysis is a specific subset of medicare) - but even so there can be other expenses (especially transport). My father has a good medicare supplement, and thus between the two we rarely see any type of bill.

My father is often cold after the procedure, but generally tolerates it well other than that.

He sees it as his "work" and basically now tells the days of the week by "is this or isn't this a dialysis day?"

There are a lot of horror stories I'm sure. As with any continual medical issue. Every once in a while he'll say they had to call an ambulance for someone. (It's only happened for him once). The caregivers at dialysis (renal nurses, etc..) seem dedicated and on top of things, but there have been some things that have been questionable. So, I regularly am in touch with them to make sure that things are done the way that seems to have the least negative effect on dad. (People leave and new people start and they aren't necessarily told what works best for my father).

I hope that your mom's kidneys stay in CKD and don't progress further. Dialysis is life-saving, certainly - but it's not optimal.

Best to you both.
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Old 04-26-2018, 01:30 PM
 
422 posts, read 340,786 times
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Have you discussed the water drinking issue in depth? One thing that we see with our family seniors is that they do not want to drink because going to the bathroom is a bother that they want to minimize. By restricting their fluid intake they reduce the number of trips, but they also put themselves at risk for kidney issues and UTI's. Is there some accommodation that you could make for her that would make toileting easier? Simpler clothing, favorite chair closer to the bathroom, etc.
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Old 04-28-2018, 12:36 PM
 
Location: Space Coast, FL
849 posts, read 219,734 times
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Quote:
Originally Posted by sweetana3 View Post
Does she just not like pure tap water? How about those slightly flavored waters? I love them and they are cheap. No bad additions just a taste of something like lemon or orange. I dont really know what has been tried but I dislike plain water and do love all the different things I can try.

There are even flavored sparkling waters if she likes that.
I think part of it is mental as she is always saying how her mother never drank a glass of water in her life, to which I remind her that her mother died at 75.

Quote:
Originally Posted by Briolat21 View Post

My father is on dialysis (he's 90) -and has been on it for nearly a decade (in that respect, he is far from ordinary). He tolerates it very well, but my understanding is that it can be very hard on people. To be honest, if he were just now being diagnosed, etc.. I question whether we would start dialysis, or just accept that he has a fatal prognosis.

If your mother is otherwise hale/hearty, and it gets to the point that she needs dialysis -she may do fine. If not, then is it something that really should be pursued?
It's hard to define her health. Some days she sleeps all day and wakes up completely in a fog not knowing where she is and frightened and very, very disoriented. Then days like today she woke up alert and energetic and itching to get out on her scooter. She is very limited mobility wise, but the scooter gives her an outside life. She is very weather effected which is why we moved to Florida. On rainy days, she is lethargic and very depresssed.

Quote:
Originally Posted by Prumio View Post
Have you discussed the water drinking issue in depth? One thing that we see with our family seniors is that they do not want to drink because going to the bathroom is a bother that they want to minimize. By restricting their fluid intake they reduce the number of trips, but they also put themselves at risk for kidney issues and UTI's.

That's exactly why she doesn't like water, but since the diagnosis I keep a bottle of cold water next to her. She drinks about half in a couple of hours then I put another out there. But she knows the extra walking is helping her greatly. So I'll keep trying.

Thank you for the feedback everyone!

Jules
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Old 04-28-2018, 08:59 PM
 
3,563 posts, read 2,964,225 times
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Do you have a number for her GFR? (Sometimes called eGFR, for estimated glomerular filtration rate). CKD is staged on the basis of GFR and albuminuria (amount of albumin, a protein, in her urine). Lower GFR = worse kidney function. Higher albuminuria = worse kidney function. I agree the creatinine is high, but I have seen it much higher than that in my patients whose kidneys are actually failing. They are in ESRD, as another poster noted.

I have had many patients in their 80s and 90s whose GFR stabilizes in the low 30s or even mid-to-high 20s, and they don't need dialysis. Dialysis is generally started when GFR drops below 15 and almost always by the time it is 10 or below. But the conversation about dialysis has to start earlier than that, to allow time for the surgical creation of vascular access (assuming the person is doing hemodialysis).
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Old 04-29-2018, 12:57 AM
 
Location: El paso,tx
3,545 posts, read 1,420,860 times
Reputation: 6436
Quote:
Originally Posted by Forum_Newbie View Post
I think part of it is mental as she is always saying how her mother never drank a glass of water in her life, to which I remind her that her mother died at 75.



It's hard to define her health. Some days she sleeps all day and wakes up completely in a fog not knowing where she is and frightened and very, very disoriented. Then days like today she woke up alert and energetic and itching to get out on her scooter. She is very limited mobility wise, but the scooter gives her an outside life. She is very weather effected which is why we moved to Florida. On rainy days, she is lethargic and very depresssed.




That's exactly why she doesn't like water, but since the diagnosis I keep a bottle of cold water next to her. She drinks about half in a couple of hours then I put another out there. But she knows the extra walking is helping her greatly. So I'll keep trying.

Thank you for the feedback everyone!

Jules
Dehydration can cause lethargy and mental degradation. I'd do everything possible to get more water into her. Flavored waters might work. I'd try to avoid tea and coffee since they have a diuretic effect.
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Old 04-29-2018, 03:09 PM
 
4,225 posts, read 1,737,273 times
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Did the blood test check her uric acid level? If not, above normal uric acid can translate to bad kidney numbers. Once the uric acid is reduced to low normal values with medication, the kidney numbers normalize.
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