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    Old 09-10-2004, 12:07 PM   #1
    kjarels
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    Slightly elevated creatinine

    My creatinine has been tested twice within a years time and each time it was 1.4 and normal is .5-1.2. I have switched doctors since the first testing and this dr did not seem concerned about that reading. I have been on benicar and a water pill and I read that benica could change kidney function in some people but this doctor said no. What do you guys think?

     
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    Old 09-11-2004, 08:59 PM   #2
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    Re: Slightly elevated creatinine

    Quote:
    Originally Posted by kjarels
    My creatinine has been tested twice within a years time and each time it was 1.4 and normal is .5-1.2. I have switched doctors since the first testing and this dr did not seem concerned about that reading. I have been on benicar and a water pill and I read that benica could change kidney function in some people but this doctor said no. What do you guys think?
    This creatinine reading is not too high, and as long as it's staying constant, it's not a big deal. Do you know if it's been increasing?

     
    Old 09-11-2004, 09:04 PM   #3
    butterflytrans
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    Re: Slightly elevated creatinine

    Oh! I didn't realize which medication you were talking about. Benicar, is I think the drug you're talking about, and it belongs to a class of drugs known as ACE inhibitors. ACE inhibitors are excellent blood pressure medications, and they are known to cause a slight rise in the creatinine of patients who are on them. There is no problem with this if the person already has good baseline kidney function. This is the reason your doctor was not alarmed by the small rise.

     
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    Old 09-14-2004, 04:56 AM   #4
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    Re: Slightly elevated creatinine

    Benicar is a member of blood pressure meds called ARBS but they can cause a decreased kidney function in some people so I really do not know what to do at this point, once last year when I had my creatinine checked I did not take my meds and my creatinine was at 1.1 within the normal range so that is making me think its the meds causing mine to increase. What do you guys think?

     
    Old 09-14-2004, 08:27 PM   #5
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    Re: Slightly elevated creatinine

    Quote:
    Originally Posted by kjarels
    Benicar is a member of blood pressure meds called ARBS but they can cause a decreased kidney function in some people so I really do not know what to do at this point, once last year when I had my creatinine checked I did not take my meds and my creatinine was at 1.1 within the normal range so that is making me think its the meds causing mine to increase. What do you guys think?
    Shoot! I'm sorry kjarels....I was thinking ARB and I wrote ACEi by accident.

    Anyway, the same goes for ARBs....doctors will allow for a 20% increase in serum creatinine before they deem that the drug is not safe to take.

    Additionally, it doesn't seem like your kidney function is that bad--I'm having trouble correlating it because the units in Canada are different, but I don't THINK it's too bad. The thing with ARBs and ACEis is that you can't give them at ALL in patients in renal failure (whether chronic or acute), but in a person with good baseline function but some renal damage from, say hypertension or diabetes, giving the ACEi can prevent renal failure way down the road.

    Last edited by butterflytrans; 09-14-2004 at 08:30 PM.

     
    Old 09-15-2004, 08:27 AM   #6
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    Re: Slightly elevated creatinine

    What would cause the ARBs to decrease kidney function? Wouldn't you have to have a problem with your kidneys to begin with in order for them to cause any problems?

     
    Old 09-15-2004, 09:36 PM   #7
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    Re: Slightly elevated creatinine

    Quote:
    Originally Posted by kjarels
    What would cause the ARBs to decrease kidney function? Wouldn't you have to have a problem with your kidneys to begin with in order for them to cause any problems?
    Well, no, you don't have to have bad kidney function for the ACEi or ARB to cause a slight decrease in your renal function.

    I'm not sure how familiar you are with kidney physiology, but I'll give the explanation anyway.

    The kidney's filtering unit is called the glomerulus, it is fed by the AFFerent arteriole, the liquid part of the blood which is filtered at the glomerulus goes in to "bowman's capsule" and then what's left after the liquid stuff has been removed goes away from the glomerulus via the EFFerent arteriole.

    There has to be some back pressure from the EFFerent arteriole, to help force the blood through the glomerulus....if there isn't, the blood will follow the path of least resistance, and instead of being filtered by the glomerulus, will go straight in to the efferent arteriole unchanged.

    ACEis and ARBs dilate both the AFFerent as well as the EFFerent arteriole, but have a greater effect on the latter. Thus, there is a slight decrease in the amount of blood being filtered at the glomerulus and you get a slight decrease in renal function.

    In a person who has lots of renal function to spare, this is not a big deal, but for someone with chronic renal failure, they can't be put on one of these drugs because they don't have much function to spare.

    There is a benefit in certain situations to this decline in filtration at the glomerulus. There are certain conditions such as diabetes where the person will start to spill proteins across the glomerulus--normally proteins don't cross at ALL. This is bad because, over years and years, the chronic presence of protein in the urine damages the kidney. So by giving an ACEi or an ARB, the pressure across the glomerulus is reduced somewhat, and there is less protein in the urine.

    Does that make sense?

     
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