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Old 12-14-2008, 02:00 PM   #1
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Possible to Raise GFR?

Is it possible to raise your GFR with good diet and having your BP and diabetes under control? I've read that it's not possible to raise it but only prevent further damage. I thought I saw some postings where people were able to raise their GFR by 10-20.

 
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Old 12-17-2008, 08:07 AM   #2
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Re: Possible to Raise GFR?

as far as i know,i hve not yet heard of anything. my sister is in the same boat right now. she just had her kidney labs go out of range for the very first time last month,which puts her at stage III. we both have an inherited form of kidney disease that also effects our livers. her GFR is at around 54 right now.

the thing is,alot depends upon just what IS actually affecting the functions that would determine if it is actually possible to bring that back up,you know what i mean? in our case,we have very heavy cystic develeopment which is displacing healthy kidney tissue to the point where both of our kidneys are extremely enlarged. that pressure from the cysts inwards and the outter facia is also placing alot of pressure within the kidney itself. i myself have been getting a therepy to treat my other pain from spinal cord injury called myofascial release,which also happens to release that outter fascia surrounding my kidneys too. i really do think,since both my sister and i were at pretty much the same place when we found out we even had this back in 99,that just having my fascia released every week is the only reason we have different lab numbers,but thats just a theory right now.

but your case is very different considering what is causing the slow failure of your kidneys. i would just do as much research as possible right now and also have an in depth chat with your nephrologist too and see if lifestyle changes would help. sorry i don't have anything magic to tell you. sometimes there just isn't anything that can raise numbers in any of our labs. those numbers change because of damage to the organ or something that is impeding their functions. sometimes there just isn't any real treatment for that, but like you mentioned,you can in some cases,keep it from becomming worse,and that IS something. please let me know if you actually find out something,K? take care,Marcia

 
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Old 12-17-2008, 11:09 AM   #3
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Re: Possible to Raise GFR?

Noodles,

I have to disagree with feelbad on this one. I have personally raised my GFR from 17 to about 40. My neprologist put me on a complicated medication regime that not only saved my life, avoided transplant, and dialysis. It CAN be done. I am now back to camping, and even riding my motorcycle in the desert, and I am a 48 year old woman!

You are right about focusing on diet and BP/diabetes control. It does however, take time. My kidney function was lost due to high BP, resulting in strokes. That was 5 years ago now, without missing a dose of medication, throwing out the salt shaker, and diving into the leafy greens, fruit and a little lean meat. (There is excellant kidney friendly dietary infromation available on-line).

I wish you the best!

Last edited by writeleft; 12-17-2008 at 11:11 AM.

 
Old 12-18-2008, 07:54 AM   #4
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Re: Possible to Raise GFR?

wow,i never said it wasn't possible,just that i had never heard of it. thanks for that very important info write. that really is amazing. just what actual meds did your neph use to help raising that GFR back up? i am only asking since i will be in this situation very soon,now that my sisters labs have changed i know that i am not far behind her. any info you can give would be very much appreciated. thanks again write,Marcia
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Old 12-19-2008, 09:18 AM   #5
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Cool Re: Possible to Raise GFR?

This is for you Marcia...

I am happy to share whatever info I can about the positive possibilities of regaining kidney function. Of course, every case is so differant, but I hope I can at least share some hope for improving one's GFR.

Of course, getting all these medications to work for me took many months of trial and error, weekly trips to my nephrologist, and detailed daily records I took of my BP. I went through all the side effects for weeks at a time for each medication, as we tried every combination, every dosage, and I spent a good year in bed. I trusted my doctor to get me through it, and he did. Like I said, this has been 5 years in the making.

These are the medications that ended up working for me:

Labetolol 200 mg 3 times daily total 600mg/day
Benicar HCT 40-12.5 mg 1 time daily
Norvasc 10 mg 1 time daily
Tekturna 150 mg 1 time daily
Lasix 40 mg 1 time daily
Allopurinol 100 mg 1 time daily to prevent gout, caused by HCT
Aspirin 81 mg 1 time daily

Requip 1 mg 1 time daily to treat RLS-side effect of stroke
Lipitor 10 mg 1 time daily to maintain cholesterol level

I must give credit to my husband and children for supporting me, and most of all for their patience...which I think must be the most important aspect of my personal success. I wish you and your sister the best, and to anyone else struggling with kidney disease. I am always here to encourage others with this, and like feelbad said.....anything is possible!

Hope this helps!

 
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Old 12-26-2008, 07:36 PM   #6
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Re: Possible to Raise GFR?

Hello,

I didn't know it was possible to improve one's GFR with medication. I would think a lot depends on the cause of the impairment in kidney function and the extent of physical damage to the kidney tissue. Mine were damaged by blood clots. Knowing there are people who have raised their GFR is great news! Thanks for sharing! My nephrologist says that the actual GFR numbers are not that important. What counts and what he goes by is whether or not the kidney function is stable. I am not sure what criteria (if not the GFR) are used to determine this.

FG

 
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Old 12-27-2008, 08:23 AM   #7
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Re: Possible to Raise GFR?

GFR alone is just one indicator, its putting the creatinine together with the GFR that really kind of measures the overall functions the best. these two things are really what i look for whenever i get my lab results back. of course alot of other factors too play into this as well,but putting the two indicators together really is kind of the standard of how well,overall your functions are doing. Marcia
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Old 12-27-2008, 08:54 AM   #8
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Re: Possible to Raise GFR?

Quote:
Originally Posted by noodles886 View Post
Is it possible to raise your GFR with good diet and having your BP and diabetes under control? I've read that it's not possible to raise it but only prevent further damage. I thought I saw some postings where people were able to raise their GFR by 10-20.
Hey noodles:

There are a few situations where the GFR can raise, most of them are bad, but a few of them are good.

The bad way one's GFR can raise is exactly in the boat you are in: diabetic kidney disease. In general with age, one loses about 1ml/min of GFR a year; however, if you have full-on diabetic nephropathy, you lose 1mL/min per MONTH. In the first stage of diabetic nephropathy before the damage starts occurring, you get a period of "hyperfiltration". Your GFR will seemingly go up in this case, but it is not a good thing.

In pregnancy, one's GFR will also go up due to smooth muscle changes around the body, though this is not a bad thing like in diabetic nephropathy.

The other ways one's GFR can go up deals with teasing out the different TYPES of kidney failure one can have. Feelbad is actually correct, but so is, writeleft. The big issue is the difference between chronic kidney failure and acute kidney failure. For most cases, CHRONIC kidney failure is irreversible whether it is due to hypertensive nephrosclerosis, or glomerulonephritis or even diabetic nephropathy. Why? Because the chronic part of ALL of these conditions results in scarring of the kidney which essentially reversible. (Yes, I know there are medications which have anti-fibrotic effects, but the amount of fibrosis they can reverse does NOT result in a measurable rise in kidney function). HOWEVER (and this is a big however), in chronic kidney failure, there are often elements of ACUTE kidney injury which CAN be reversed.

Acute kidney injury can happen from a number of mechanisms, which are divided in to:
prerenal (things which affect blood flow to the kidney)
renal (something screwing up inside the kidney itself)
postrenal (something blocking the kidney from draining, thus impairing kidney function).

Pre and post-renal kidney injury are the easiest to reverse, and this is what was likely reversed with medications in writeleft's case.

1. Sometimes medications THEMSELVES can result in prerenal injury, the most common being NSAIDs.
2. Additionally, staying hydrated or taking way/reducing medications causing dehydration (like diuretics) can help kidney function.
3. ACE inhibitors are ESSENTIAL in the management of diabetic kidney disease. They help reduce the pressure on each individual glomerulus in the kidney thereby slowing down damage. Paradoxically, they can actually result in somewhat of a DECREASE in GFR, but overall looking at the picture, the amount of slowing down they do of the kidney damage will result in a small increase in the long run.

Kidney damage from RENAL problems is much harder to treat, but it can be done. This is more of an issue in things like inflammatory glomurulonephropathies which are often a result of a disease which is affecting the whole body. An example of this is something like Wegener's granulomatosis or something like hemolytic-uremic syndrome. In this case, by treating the underlying illness (with VERY potent anti-inflammatories and immunosuppressants) you can thwart the ACUTE kidney injury. Unfortunately, after scarring has occurred, there is not much you can do.


SOOOOOO, after that long-winded response, the point is that acute kidney injury can definitely be reversed thus increasing one's GFR, but chronic kidney injury (correlating to scarring at the microscopic level) can NOT be reversed.

 
Old 12-27-2008, 09:01 AM   #9
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Re: Possible to Raise GFR?

Quote:
Originally Posted by feelbad View Post
GFR alone is just one indicator, its putting the creatinine together with the GFR that really kind of measures the overall functions the best. these two things are really what i look for whenever i get my lab results back. of course alot of other factors too play into this as well,but putting the two indicators together really is kind of the standard of how well,overall your functions are doing. Marcia
Feelbad, VERY respectfully I disagree with you here.

GFR is the gold standard of the measurement of kidney function. CREATININE is actually just the indicator. HOWEVER, there are different ways to measure the GFR. There are three main ways the labs measure GFR:

1. Creatinine clearance, which is done through a 24-hr urine creatinine clearance.
2. Urea clearance, which again is done through a 24 hour urine.
3. The MDRD GFR equation which uses one's serum creatinine, along with age (and race if you are black) to calculate a GFR.

(There are other ways, but are much less commonly used).

feelbad, when you are talking about serum creatinine and #3 above, then I somewhat agree that you should look at both of them, but STILL the GFR is the better measurement. However, if your body type is not average (i.e. you are really skinny, really obese or are really muscular) both measurements are not helpful.

Calculating GFR by measuring creatinine clearance tends to slightly OVERestimate one's GFR because in addition to filtering creatinine (which is measured in the urine) the renal tubules also secrete some creatinine. This results in a slightly higher amount of creatinine in the urine which is present from filtration alone, so the GFR is slightly higher than it actually is.

GFR from urea clearance slightly UNDERestimates because, while urea is filtered, it is also REABSORBED by the distal collecting duct. So, the amount of urea measured in the urine is slightly lower than the actual amount filtered.

The best way (other than using a radiotracer) for calculating GFR would be to take 24 hour urea and creatinine clearances and average them.

 
Old 12-28-2008, 08:36 AM   #10
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Re: Possible to Raise GFR?

thanks for that info gran,you really ARE an amazing wealth of knowledge. i have read your posts in the infectious disease boards as well as here. ya know,i suffer from very advacned PKD and amazingly all my labs have been still within all the normal ranges. i found out i actually even had a kidney/liver disease after my son(then only 12) went into 'suprise" liver failure and we had to be tested to see where this came from. of course it was my side. what really kind of shocks and amazes me about this whole thing is my labs are still within all norms(tho i do show protien and blood in my urine),but if you took one look at my ultrasounds you would never possibly imagine that my labs and those pics came from the very same person. they are simply humongous right now with my right one getting so freaking huge it actually popped out of my back and had been sitting in the front partly alongside and under my right ribcage since 05? the kidneys just 'look' horrid,but my functions are still great(according to just the labs alone). go figure. my sisters labs went out of range for the very first time last month so i figure i am not too far behind. but it just sooo totally freaks me out that any person can actually show that much real damage and have labs like mine,ya know?

i did have that 24 hour collection testing done way back when i first found out about this nightmare,but really never found out the results. i do have a good neph who has been monitoring things but with PKD,there really is not anything that you can realistically 'do' to stop the progression of this. (when it comes to the GFR and the creatinine,i do know they use the combo of both to actually determine actual stages of kidney failure) it just goes and goes til things hit the fan. believe me,it was a shock to find out at around age 40 that i had been living with this crap affecting both kidneys and my liver my entire life but it just never showed itself. if my son hadn't almost died from portal hypertension then liver failure, the PH was the first real indicator of his liver disease,which eventually required Tx,i really don;t know just when i would have found this out since the labs are amazingly still in those good ranges. i just know i do have real damage. its just a matter of time now. the one good thing about PKD is that it doesn't actually 'take over'(say,like a cancer would?) healthy kidney tissue,it actually displaces it,hence the totally humongous kidneys that are now taking over my entire abdominal cavity. like i said,it just totally freaks me out. thanks alot for your input and the amazing knowledge you have in that head of yours. i do understand some things much better now. marcia
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Old 12-28-2008, 11:59 AM   #11
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Re: Possible to Raise GFR?

Hey feelbad...thanks!

Yeah, ADPKD is quite a nightmare especially given how insidiously it can onset and then present suddenly. I'm not surprised your kidneys function is totally normal, because as you likely know, it stays normal for a very long time for people with the disease.

Have you had any other manifestations of cystic disease outside of the kidneys/liver? Any aneurysms, diverticulae or mitral valve prolapse? These things are often associated with ADPKD.

Pretty much the only thing that has been shown to have somewhat of a change in the course of the disease is the controlling of the blood pressure. As you correctly mentioned, the cysts don't replace the normal renal tissue until way later when the normal renal parenchyma starts to fibrose. The fibrosis can be accelerated with hypertension, so it's essential to keep it under control. Cyst debulking procedures have been tried with some success, but the results are mixed, and because the surgery is often associated with a lot of bleeding and is not worth the risk.

Have you had trouble with any cyst infections or anything?

 
Old 12-29-2008, 07:08 AM   #12
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Re: Possible to Raise GFR?

yep, i do have and my sister too have the kidney and the liver cysts. i also have two of those little SOBs sitting in my psoas muscle now too,geez. now those two in that muscle REALLY are bothering me at this point. luckily for me i have not had any UTIs or even attempted any type of deroofing or aspiration procedures(like that would actually work anyway?),mainly becasue i have a really great neph who is thinking that as long as it aint broke,don;t go there type of additude? it just opens a route for possible infection and other issues so i am just trying to deal with the enormous size in my little small frame 5'2" body,i also only weigh around 92-96 lbs on a good day.

i did develop a brain aneurysm back in 05. luckily i had a wonderful neurosurgeon at the time who was thorough enough to send me for an MRA that found it(never had ANY real head pain,just insane flushes of heat that started at the mid top of my head ad flushed down thru my c spine and stopped). it never showed on MRI. thankfully it was coilable. i was also born with another vascular malformation right smack inside of my spinal cord which my NS was also more than likely due to my PKD. that weaker vessel wall thing? it was a cavernous hemangioma and it was bleeding into my cord off and on so it did need to come out. unfortunetly it was not in a 'favorable' spot for surgery and alot off things got damaged. had to go on disability after that little number. this glob just showed up on an MRI of my c spine when i just wanted to find out what disc was herniated in my c spine. it was right at the c 8 nerve level? was not expecting that one. one kind of "good' thing that came out of this spinal cord damage was it also somehow damaged my SNS which in turn gave me hyPOtension,so my BPs are mostly on the lower side? that kind of was already there with me but this brought them down even more,so the BP thing is not something i worry about too overly much? at least one thing out of this nightmare to be thankful for.

my son REALLY got hit with some major bizzare stuff happening to his liver from this disease. he recieved a mutated gene offshoot of the PKD gene and actually was born with little fibers taking over his liver little by little(congenital hepatic fibrosis). did NOT have a clue he was even sick til he presented in portal hypertension and threw up ALOT of blood at school one morning. insane,let me tell ya. he had just started 7th grade and was basically dying from liver failure that we just never had a clue was even going on. he actually had 'just' had a sports physical less than a month and a half before this nightmare day and the stupid NP who did that physical which supposedly also included palpating his abdomen??? hello? gave him a glowing report and cleared him to play sports,despite this hugely displaced hardened liver sitting right in the middle of his abdomen in the upper,the liver was NOT neatly tucked under the ribs. i have no freaking clue as to just what this NP thought she was feeling when i KNOW she had to have felt that area and at least wondered? what saved his little butt was that he decided at the last minute he didn;t feel like playing or that very first hit he would have taken full into his abdomen would have exploded his liver. when his GI doc told me that honestly,i almost hit the floor. talk about stupiditiy. that NP WAS fired almost immediately that day i brought him back to see(very emergently) an actual doc after that blood vomiting episode. after that day it was all kind of a huge blurr ya know? he ended up getting his tx on june 7 2000. that liver has been like a gift from god. its been running amazingly well pretty much from the git go. its like it was made for him. even his tx doc said so when he said he looked at it for the first time before placing it in our son. it was a very perfect match for him and his anatomy in every single way.

PKD has been such fun around here. my son also of course has the cysts in his kidneys too but no where near where mine are at right now. he is now 21. the one really crazy thing that i have found with this particular disease is it tends to show itself in very different ways in any given family unit? the really crazy part here is my mom had to have been the one who gave this to me and my sister(all of my moms cousins,and two aunts have this only in their kidneys,not any liver involvement) but yet she shows NO real signs of the characteristic poly globs of cysts,she simply does not have this. neither does her brother but yet his two daughters have had between them,one of them developed a brain aneurysm about seven years ago and the other one has had UTI problems since she was a kid,but no actual cystic development within the kidneys either. very crazy. its like the more bizzarre crap that happens just really makes me want to really dive into researching this whole thing,its just that insane whats occured in just my little family alone. it just seems to create its own little individual family ways of showing itself.

so we sit and wait for the inevitable to occur at some point. my kidneys are just so wayyy too big for my body right now its crazy. luckily i do have a good pain management doc who i was already seeing because of the fallout from my SCI and other crap in my c spine i am dealing with,so that has helped. but it of course sucks. if you are still reading this,thanks. i know its been quite a looong drawn out nightmare just with this crap alone,espescially for our son,but the added junk in my cord i really did not need ya know? but we are managing with good support systems in place. couldn;t get thru this crap without it ya know? thanks again for your info gran. Marcia
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Old 12-30-2008, 10:00 AM   #13
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Re: Possible to Raise GFR?

Whoa! Sounds like you've had quite the experience especially with your son involved.

I'm not sure if this is going to make you feel better, but don't be too angry at the NP. Physical examinations--especially for abdominal stuff--are notoriously unreliable. Usually the liver is "tucked under the ribcage", yes, but not always. It's quite normal to sometimes feel it poking out. I'm surprised, though, that if he had portal hypertension enough to cause variceal bleeding (which is what he must've had at school that day) that he didn't have other signs such as ascites and leg swelling. Interestingly, most people who have cirrhosis and portal hypertension have SMALL livers that you can't feel very well.

Did your son's doctors know he had congenital hepatic fibrosis BEFORE he had the vomiting episode?

 
Old 12-31-2008, 08:44 AM   #14
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Re: Possible to Raise GFR?

i still don't get the not feeling what WAS most definitely a very hardened and enlarged liver,that much we did know one things hitthe fan. according to the GI doc at the U of MN where we ended up,she too was just blown away that the NP could not have felt this,it was just THAT big and hard as a rock by thattime.

no,we did not have even the slightest clue that he had,or we had,anything actually wrong before that vomiting episode took place. he had been having reoccuring vomiting at strange times but his ped said he was fine,go figure. the nosebleed thing actually runs in my hubbys side of the family,with every single member i think just getting these sudden onset nosebleeds out of the blue. no high BP or any other issues,they just got these from time to time. my hubby had them since we had been married,then my oldest son stared getting them too,so when the other son started getting them,well of course his ped just assumed,and we did too that these were just a familial thing and would go away eventually(they all eventually did go away). so that 'symptom" of the impending P hypertension was just reasoned away and not given the gravity it deserved. the only really different thing he had was whats called a nevis or spider angioma right under one eye on his cheek. but i too had these little things pop uop as well when i was a kid,and his doc never mentioned anything about it,so we just assumed once again that this was "normal' too given my history. well of course it wasn't. the more that the liver failed the worse this thing got. right before that first vomiting episode it was very bright cherry red with very tiny reddish cappillaries surrounding it. when they finally decided to do a TIPS on him,after it was performed and that pressure reduced,that color went down alot to the "just" dull red it was pre p hypertension.

our son was actually one of the very first ped patients to ever have that TIPS performed on him. before they decided to do this on him,we were told we were going to have to go thru that horrid banding procedure like over and over? and it would not have gotten rid of that major major risk and problem of too much pressure being there either. so the TIPS really went well for him and did help alot. but once he developed pancreatitis that went unDxed for months by his stupid resident GI doc(she never once ever checked his amylaise or lipase at any appt he had,despite this ongoing nasty left sided pain he was constantly having?),not his actual good klnowledgable doc who we did not see for follow ups unfortunetly? things just went downhill from there til he actually was reDxed with having primary sclerosing cholengitis,go figure. this was not there according to what we were told at the original dx of the CHF. they don;t know how in the heck it changed into PSC but it did. then we were screwed since my hubby has been planning to donate a lobe of his liver and we did have a date set for this and my hubby had run thru and passed every single type of test they did on him? becasue of the new dx he was going to need a whole new cadaver liver,not just that lobe anymore. that was a very very bad day,trust me. now we waited on the freaking list and just hoped and prayed alot ya know?

things got pretty ugly in just a couple weeks time with that new Dx and them not being able to even get a tube into the bile ducts to drain what had become a horrid infection. the interventional rad(LOVE these guys and what they can do) said it was like trying to push a straw into a rock. he got moved up to status 1a and was listed in grave condition and given only hours when we got that new liver. it was wayyy out of our normal region so i do know that if they had not moved him onto the national list at the time they did,we never would have gotten that lifesaving liver in time. what a blessing.

it has been quite the time let me tell ya. we just didn;t have a freaking clue any of this stuff was going on inside him like since birth? none of the symptoms ever actually just occured at one time where that little red flag would have gone up that said,hey,something is really wrong here? it was all spaced out over like years of time and some things just simply explained by other things. honestly,just given what our son has been thru and what strange and insane things have also been found along the way going on in me,you just really have no clue at all what IS going on inside your own freaking body til something creates that need to scan something or look at it inside a bit closer. that is the one huge thing i learned many times over from all this crap. honestly,just how really insane is this ya know? thanks for listening gran. have a great new year,K? Marcia
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Old 01-01-2009, 11:38 AM   #15
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Re: Possible to Raise GFR?

Happy new year to you too!

Man, that is quite the story. I am a little confused now though: congenital hepatic fibrosis is quite different than primary sclerosing cholangitis. Which one did he have? If your son had (has) PSC, does he have any associated inflammatory bowel disease like ulcerative colitis?

Also, you obviously have ADPCKD, did he have any problems with cystic kidney or liver lesions?

 
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