QUESTION: hi,i am 79 and have moderate kidney damage.i take 15mg of remeron for sleep.does the fact that remeron stays in your body over 20 hrs have a harmfull effect on kidneys.also the natl kidney assoc said men over 75 who have no protein in urine/but low gfr cannot be at high risk for kidney damage,no matter what category doctor puts you in

ANSWER: Frank,

Thanks for asking my opinion on "Allexperts".

Mirtazapine (Remeron) has a reduced clearance in patients with impaired GFR. Close monitoring is advised. You have not mentioned your creatinine value or eGFR. so I cannot provide specific recommendations. Please discuss with your Nephrologist.


Dr. Shah

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

QUESTION: you did not answer question about natl  kidneyyassoc new guidelines that men over 75 with low gfr but no albumin in urine are not considered kidney damage of importance no matter what category kidney doctor states.

ANSWER: Hi Frank,

Thanks for following up with me.

Can you please point me in the right direction for the guidelines that you mention?


Dr. Shah

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

QUESTION: there were quite a few articles written by richard glasscock one of the best in nation.the articles show evidence that no formula today,accurately predicts gfr in men over 75/the articles state in people over 70 a gfr between 45-59 usually means nornal kidney function in a 75 year old mam,but doctors  today put thesepeople in wrong kidney desease stages.natl kidney assoc revised statemen said people over 75 with low gfr,and no albumin in urine do not have high risk kidney desease,no matter what doctor says.the serum creatinine amd mard formula are not reccommended for men 75.we are starting to realize with many studies,that in men over 75 protein in urine is better indicator of cardiac desease and kidney problems .urine tests more accurate then gfr.hope this helps and would like your comments/you are a cool guy of course you have quite a few nephrologists that have tunnel vision,ignore the reports and continue outdated gfr with serum creatinine.this test today is not even used in austria and parts of europe.waiting for your comments*******


banks for following up on our previous conversation. I do agree with what you mention.

Even in normal individuals, GFR falls at the rate of 1 ml/min/yr after the 3rd decade of life. An eGFR calculation can be a useful tool in diagnosis just like a detailed history & physical exam in a patient suspected of having COD.


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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Ten years as a Critical Care & Transplant Nephrologist

International Society of Nephrology
Indian Society of Nephrology
Indian Medical Association
European Renal Association

- 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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