Can someone help me? - Kidney Disorders Message Board

Lithiate · 06-07-2003, 10:37 PM

I'm in a real bind! My primary concern was to get treated for hypothyroidism, which was darn near impossible until I opted to pay out of pocket for an endocrinologist to treat me (I'm one of the "lucky" ones who look normal on most blood tests but remain symptomatic). Well, to make a long story short, this specalist ran a series of extremely expensive tests on me and somehow uncovered the possibility of kidney failure in my future. He went to great lengths to convince me that I needed to start a low dosage of blood pressure medication to prevent my proteinuria from advancing (I guess there's something about blood pressure meds that bind to protein in the kidneys and prevent it from being excreted, but he was pretty vague about it). Needless to say, this scared the dickens out of me, so I went back to my HMO for a second opinion and brought along a copy of the tests the endocrinologist had performed. My GP went over everything and couldn't figure out how the endo had come to the conclusion that I had proteinuria, let alone kidney failure of any kind. To be extra sure, he ordered up a repeat of the kidney function tests, albumin, calcium, etc. Well, the results just came back and I'm "normal" in everything except for my BUN (blood urea nitrogen) which was slightly low (the nurse practicioner I spoke with said this could be because I drink a lot of water and my urine was diluted).

My big question is, who do I believe? Should I trust the endocrinologist who wants me on blood pressure meds to treat a disease that no one can figure out how he detected it? Or should I trust my HMO which has given me the run around in the past on other issues? Also, if a test is still within range, but in the upper part of that range, is it really normal? Being a thyroid patient, I've learned to mistrust lab ranges, so you can see where I'm coming from. I have no history of diabetes, or kidney failure/disease in my family, so this really comes out of left field.

Any advice would be greatly appreciated!

Sarah68 · 06-09-2003, 07:13 AM

I would be more tempted to go with your primary health care doc at present, especially if there is no history of renal disease or diabetes within your family. Also, blood test results that come back on the slightly raised or slightly below normal limits can also be ok and you do not need to worry about them.

Also, if you drink a lot of water, this is very good for flushing your kidneys through and helping renal function and can make some levels lower due to the dilution of urine.

Also, blood pressure meds do not work by binding to protein receptors in the kidneys. As the name suggests, they work by affecting the pressures and permeability within the kidneys themselves. The more usual blood pressure meds to be given are known as ACE inhibitors - Angiotensin Converting Enzyme Inhibitors. These action on the Renin Angiotensin system within the kidney itself and changes the pressures and makes the parts of the kidney tubule, mostly the proximal convuluted tubule more sensitive to pressure changes. It also affects the permeability too, where by more or less substances are absorbed or excreted under the effective of both active and passive transport.

Anyway, I really would not worry to much and maybe trust your primary health care doc on this particular occassion, especially going on your past family history. If you are really worried, then you could always go and see another primary healthcare doc for another opinion and see what he thinks. Get him to repeat the tests and see.

Also, I do not know whether you are taking blood pressure meds at present? If you are then be careful, because if you are taking them without the need, you can make you feel unwell, especially if they make your BP drop to a lower level than it would normally be at. You can feel dizzy and weak and could get dizzy when you suddenly stand up from a lying or sitting positing - (postural hypotension or you may know it as orthostatic hypotension).

Good luck