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Nephrology/Diarrhea and abnormal numbers


QUESTION: I am male and my age is 32. My blood glucose level used to be about 90 mg/dL, but urea, creatinine and potassium weren’t tested for years.
A month ago, I had diarrhea for several days. The results of the blood test (5 hours after meal rich in protein and potassium) were:
glucose: 108.80 mg/dL (normal levels according to the lab: 74-106), urea: 52.99 mg/dL (normal: 16.6-48.5), creatinine serum: 1.63 mg/dL (normal: 0.7-1.2), sodium: 145.59 mmol/L (normal: 136-145), potassium: 3.32 mmol/L (normal: 3.5-5.1). It is possible that I was dehydrated due to diarrhea, but MCHC wasn’t elevated.
In the next few weeks, I was OK, but in order to avoid diarrhea and high urea I changed remarkably my eating habits (no fish, milk products and orange juices, which were the main sources of potassium and protein for me). The results of a new blood test (10 hours after meal) were:
glucose: 126, urea: 32, creatinine serum: 1, sodium: 141, potassium: 2.7. Traces of ketone (+) and traces of protein were also found in the urine test I asked.
After that, I followed a diet rich in potassium for six days. The results of the last blood test (10 hours after meal) were:  
glucose: 121.80, urea: 23, creatinine serum: 0.80, sodium: 142, potassium: 3.63 (no urine test this time).
My questions are:
1)   Can I expect that glucose will become normal again in a few weeks time, provided that potassium is a bit more increased and stabilized or is it totally irrelevant?
2)   Do you think that there was a kidney problem either as a result or as a cause for this situation? Should I visit now a nephrologist?
I admit that this situation, diarrhea at first, then the idea of repeated tests, has caused much discomfort to me and I am a bit stressed and this probably makes things worse, so I would appreciate your answer! Thank you in advance!

ANSWER: Costis,

Thanks for your question on "Allexperts".

The first set of tests were abnormal probably because of dehydration caused by diarrhea.

I don't think that you have any abnormality in your kidney function. That said, the electrolytes, BUN and creatinine will be normal no matter what you eat. After all, maintaining equilibrium in the body is the prime function of the kidney.

Just relax and stop worrying.


Dr. Shah

---------- FOLLOW-UP ----------

The previous week I had some tests again and the results were:
glucose: 122 mg/dL (normal levels according to the lab: 74-106), serum creatinine: 0.9 mg/dL (normal: 0.7-1.2), sodium: 146 mmol/L (normal: 136-146), potassium: 3.5 mmol/L (normal: 3.5-5.1).
Ketones: (+), protein: traces, pH: 5
Kidney Ultrasound:
Size and shape: normal; Presence of “sand” (this was something I knew however, because 10 years ago I had experienced renal colic).
It’s true that I expected quite better results and I am a bit worried, as glucose and potassium levels remained roughly the same and traces of protein were found again in the urine test. Somebody told me that I should worry about whether there exists Renal Tubular Acidosis or something like that. But I don’t think that RTA could be combined with both low potassium level and so low urine pH (5), at the same time. Do you think that it needs more investigation? Should I worry about blood potassium or urine protein?
I would really appreciate your answer! Thank you in advance!


Thanks for following up with me.

I don't see any reason to worry as all results are within normal limits, except your urine. The presence of ketones and proteins needs further work up. Please get yourself evaluated by your primary care physician.


Dr. Shah


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Dr. Shamik Shah, MD, DNB (Nephrology), ISN Fellow


I can answer all questions related to kidney diseases, hypertension, plasmapheresis and kidney transplantation. I am an Indian-Board certified Nephrologist. I was a post-Doctoral Scholar at the Division of Nephrology & Hypertension,Department of Medicine, University of California, San Diego. My area of interest is Critical care Nephrology and Acute Kidney Injury.

Please mention the units in which your lab results were reported and the normal reference range for your laboratory.

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International Society of Nephrology
Indian Society of Nephrology
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- Shah SH, Cerda J. Acute Tubular Necrosis; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4, pp. 191-198
- Shah SH, Cerda J. Management of Acute Kidney Injury; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4
- Cerda J, Tolwani A, Shah SH, Ronco C. Continuous Renal Replacement Therapies in Modeling and Control of Dialysis Systems edited by Azar AT, Springer-Verlag, Heidelberg, Germany (In Press)
- Shah SH, Cerda J, Kellum JA. Acute Kidney Injury in Special Circumstances. John Kellum, Jorge Cerda, eds. Renal and Metabolic Disorders, Oxford University Press (In press)
- Shah SH, Mehta RL. “Anticoagulation in CRRT: Is Citrate better?”; Vineet Nayyar Ed. Critical Care Update 2009, Jaypee Brothers (In press)
- Shah SH, Mehta RL. “Non-dialytic management of acute kidney disease”; Evidence based Nephrology, BMJ, (In press)
- Shah SH, Mehta RL. “Epidemiology of Community-acquired AKI”; Ronco C, Bellomo R, Kellum J Eds. Critical Care Nephrology, Saunders. ISBN 1-4160-4252-0
- Abdeen O, Shah SH, Mehta RL; “Dialysis therapies in the surgical intensive care unit”; William Wilson, Christopher Grande, David Hoyt Eds. Trauma: Resuscitation, Anesthesia, and Critical Care, Informa Healthcare, NY 2007. ISBN 0-8247-2920-X
- Shah SH, Mehta RL. Acute kidney injury in critical care: time for a paradigm shift? Curr Opin Nephrol Hypertens. 2006 Nov;15(6):561-5.
- Shah, SH, Soroko S, Lischer E, Mehta RL. Delivered vs. Prescribed dose of Dialysis in Hospitalized Patients: Results of an Audit. J Am Soc Nephrol 17(Abstracts Issue): 2006, 107A.
- Shah SH et al “Biochemical Nutritional Parameters in Non-vegetarian and Vegetarian CAPD patients” Perit Dial Int 2001; 21 Suppl 2: S1-182

MBBS, MD (Internal Medicine), Diplomate of National board (Nephrology), ISN Fellow

Awards and Honors
Educational Ambassador of the International Society of Nephrology 2010
Fellowship of the International Society of Nephrology 2005.
Young Investigator Award by the International Society of Peritoneal Dialysis 2001

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