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Nephrology/WHAT STAGE CKD AND WHY HIGH POTASSIUM

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QUESTION: Dear Dr Shah. My husband has one kidney and suffers from hypertension which is often difficult to control. He has diarrhea often and no-one can find out why, so has to be careful about dehydration. In the past year his GFR has ranged between 43 and just recently 22. Most tests have ranged between 22 and 30.  One test was 40 and one 43, done close together. At the time it was 22 he was hospitalised for high Potassium level (7.8). His nephrologist took him off two tablets for hypertension which could have been causing the high Potassium.  He was released from hospital when Potassium levels were normal but next day they were up to 5.8 and then two days later 6.4. Next test they were normal. Our lab considers 3.5 to 5.5 normal. Two questions, would you consider him to be stage 3b or stage 4 CKD and why do you think the Potassium levels went up again.  He had no symptoms at 7.8 and I am terrified they could go up again and we would not know - he obviously cannot go for blood tests every day. Thank you.

ANSWER: Rose,

Thanks for asking my opinion on Allexperts.

A careful history, physical examination, imaging of the urinary tract and review of old blood work are needed to know the cause of CKD. For ascertaining the cause of hyperkalemia, a review of present medications and a food diary are needed. Unfortunately, I cannot do this over the internet.

Please discuss your concerns with your husband's Nephrologist and follow his advice. I agree that tests cannot be done every day.

Sincerely,

Dr. Shah

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

QUESTION: Hello Dr Shah
Further to the above, my husband had a U/S of his kidney.  Result came back "The right kidney is normal in size, measuring 11.9cm.  The right kidney is increased
in echogenicity, which could be
due to renal failure, nephritis.  Minimal cortical thinning noted, measuring 0.9cm.  No renal calculi noted. No perinephric collections noted. No hydronephrosis noted. Evidence of left nephrecomy with chromic changes noted of the right kidney." What should this tell me.  Is it good or bad? I have heard that with only one kidney, the remaining kidney normally increases in size. Is it possible that it did increase in size and has now got smaller due to his kidney disease?

Answer
Rose,

Thanks for following up with me.

Increased cortical echogenicity with cortical thinning is bad news. In addition, compensatory hypertrophy should have increased the size more than 11.5 cm. That said, ultrasound is a very subjective assessment and is highly operator dependent.

Sincerely,

Dr. Shah

Nephrology

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

Expertise

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.


Alternative Website
http://www.syndeohealth.com/doctors/shamik-shah/91

Experience

Ten years as a Critical Care & Transplant Nephrologist

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


Publications
- 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


Education/Credentials
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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