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Nephrology/19 year old with a 1.43 creatine level...


Good day Dr. Shah,

Just last week, my 19 year old son had his blood levels done and they found that he had a 1.43 Creatine level and a eGFR of 70.  His BUN was 16 - with the BUN/Creatine ratio of 11.  The Creatine level is up from his last test of 1.1 back in 2012 - BUN rate of 12.  He is active - plays rugby once a week now, but was very active back in 2012 wrestling 5 days a week.

To note, my son experienced a UTI at 10 days old that the infection went systemic.  They had him on some pretty serious intravenous antibiotics for approx. a month and then Amoxicillin for another 2.5 years.  Within that time, due to the continued UTI's he would get when not on the Amoxicilin, we gave him Tylenol and Motrin/Advil alternating every 4 hours for his fevers. The Dr.'s at that time warned us of two side effects of this type of treatment of the antibiotics, 1.  Tooth decay due to the teeth forming in the jaw and the effects antibiotics have on the development of them (he had significant oral issues resulting in 4 baby root canals and two caps at the age of 2 and 1/2), and 2. That we would need to keep an eye out for any kidney issues due to the type of antibiotics used.  They stated that more than likely, any issues with the kidneys would show at about puberty.

We have a referral to a Nephrologist from our PCP, but I would like to have additional information on the next tests they should order. Will an ultrasound show this type of kidney issue? Also, I would like to get your gut feeling on what might be happening to his kidneys.

"Thank you" in advance for any light you can shed on this. As you can tell, we are very concerned, but would like to get a feeling as to how concerned we should be at this time.


Thanks for asking my help on Allexperts.

You have not mentioned the normal reference range of serum creatinine for your lab. If the reading is within the normal range, you have nothing to worry about.

Repeated infections in childhood can manifest as chronic pyelonephritis and CKD in adulthood. If I were his Nephrologist, I would order a 24 hour urinary creatinine clearance, an ultrasound, serum calcium, phosphorous, alkaline phosphatase in addition to a urine microscopy and culture.

If the cause of renal dysfunction is not clear, I'd discuss the merits of doing an ultrasound guided kidney biopsy with the family.


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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