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Suggest Remedy For Mouth Dryness In A Person With Chronic Kidney Disease

Posted on Thu, 3 Dec 2015

Question: Hello! I am 59 years old, weigh 118 lbs and my height is 4ft 11.5 in tall. I am active and work out at the gym three days a week on strength training with weights. I also walk every day at least one twenty minute walk with my dog.
My eGFR dropped from 40 to 31 in three months. My regular physician diagnosed it. Does the eGFR score generally vary that much? I took a Prolia shot 5 months ago for osteopenia - could it have any negative effect on the eGFR? Three weeks ago I started using Xylitol because I was having trouble with my teeth and wanted a sugar substitute. I was wondering if this could be related to my lower eGFR score? If so is there a safer sugar substitute?
I am scheduled for a kidney doctor visit In one month. Is green tea without sugar a safer alternative for stage 3b chronic kidney disease? I am also bipolar and take medicine each day - trifluoperaz (2 mg), lorazepam (2 mg), bupropion (150 mg), divaloproex dr (250 mg). I also use estrace vaginal cream (1 g) and stool softener, docusate sodium, (200mg) each day. I no longer use lithium because that is what caused my kidney disease in the first place).
My mouth is always dry from the medicine. My doctor in the past just urged me to drink much more water to flush out the toxins. Thank you.

Answered by Dr. Rakesh Madhyastha (41 minutes later)

Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

It is unusual for someone without any pre existing problems to have a chronic kidney disease. I would want you to get a proper assessment of the renal function in order to label you as chronic kidney disease.

eGFR can fall from 40 to 30 in 3 months, it is gradual progression of the chronic kidney disease. However in order to help you and to answer your questions I need a few more details

1. Are you a chronic smoker ?
2. How long have you had hypertension and what are you taking for it ?
3, Has an ultrasound been done to know your kidney size?
4. What was your previous serum creatinine?

Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (29 hours later)

I am not a smoker.
I am not taking any medicine for hypertension. My upper number is usually 120 or lower and the bottom number is usually 80 or lower.
I did have an ultrasound of my kidneys which showed them smaller than normal but I couldn't find the exact numbers.
My previous serum creatinine was 1.44.

I developed kidney disease while being treated for bipolar disease and receiving lithium. After 20 years on lithium, my kidneys became damaged and I had to change medicines. Hello. I found the information. Renal ultrasound done which showed small kidneys. The right renal kidney 7.4 cm and left kidney 8.2 cm consistent with chronic renal failure. Done 1/28/2011. Thank you.

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
Chronic kidney disease

Detailed Answer:
Hello

Thanks for getting back

Looks like you have chronic kidney disease, most likely due to Lithium induced chronic interstitial nephritis
Here are my suggestions

1. It is important that the progression of the kidney disease is slowed down
2. Tab ACE/ARB should be added onto your medication to slow down the progression. It is proven beyond doubt that these drugs slow down progression of kidney disease
3. Exercise daily for atleast 30 min
4. Avoid nephrotoxic drugs ( please mention to any doctor that you might visit that you have CKD)
5. Avoid red meat and food rich in potassium like banana, coconut water, etc
6. Restrict salt intake. Avoid food rich in salt like chips, popcorn, pizza, pasta, etc

I hope I was of help, i am sure you have many doubts. I will be happy to clarify them

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Hello, What is Tab ACE/ARB? Would I take both or only one? What are the possible side effects? Is this related to my high potassium level mainly? I already do your suggestions 3 - 6. How much exercise is needed each day? Would the 20 minute one mile walk suffice on the days I am not working out at the gym or do I need more? Is weight training a good type of exercise? I do this for an hour three days a week. I started working out because I have osteopenia in my hip and couldn't take calcium supplements because the calcium level in my blood was/is too high. I was given Prolia to help with the osteopenia but because of side effects with my teeth I am no longer going to continue it after December. It was a 6 month shot that prohibits any dental work being done while on the shot, but it seems my teeth have gotten weaker since taking it. Also the Prolia can cause serious jaw problems. Would taking the Prolia effect adversely my kidneys? Sorry for all the questions. Thank you for your time and patience.Sorry. I forgot one question: will staying well hydrated help to flush out excess potassium, calcium, salt, and such. I don't think I have been drinking enough water sometimes.

Answered by Dr. Rakesh Madhyastha (12 hours later)

Brief Answer:
Retardation of progression of kidney disease

Detailed Answer:
Hello

Thanks for getting back. I am sorry for the short delay in my reply, I just got back from the hospital.

Since there are several questions, I will answer them one by one so that I dont miss any

1. ACE/ARB are basically anti hypertensive agents however they have property of retarding the progression of kidney disease by making kidneys work lesser. I usually start with telmesartan 40 mg once a day
2. Side effects are high potassium and a small increase in creatinine.
3. I advise my patients 30-45 min of cardio exercise daily
4. Brisk walking for 30-45 min is sufficient
5. weight training is not advisable and it is not useful
6. Please get back to me with the contents of Proila, I am not able to find it in my directory of drugs.
7. I recommend you to have a potassium and a salt restricted diet. Do not overload yourself with water, drink how much your thirst demands.

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Rakesh Madhyastha (1 hour later)

My regular physician prescribed calcium supplements after taking the Prolia shot. When my blood work came back with the calcium level so high this time, he told me to stop taking the calcium. However calcium and vitamin D are supposed to be prescribed for those taking the shot. With my kidney disease at the level it is, I cannot take the calcium. I am very wary of the side effects of Prolia and have already had pain in my gums since taking it. I made the decision to stop the shots as I now need dental work which is prohibited while on the shot. Happy New Year and may you be blessed your practice.

Answered by Dr. Rakesh Madhyastha (11 hours later)

Brief Answer:
Prolia not required

Detailed Answer:
Hello

Thanks for getting back and providing the link. I dont recommend Prolia for my patients and I try to manage mineral bone disease with the available tablets like caclium and Vit D analogues. I make sure Calcium, phosphorus, Vit D and alkaline phosphatase are within recommended limits. If your calcium is high then Prolia is an absolute contraindication.

I wish you and your family a merry Christmas and a very happy new year. Do not worry about your health, you can approach me anytime for any clarifications you might need. Please feel free to ask me as many questions as you want

Regards

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Dr. XXXXXXX Absolute contraindication means not to be taken, right? Thank you for your best wishes at Christmas. I will address future letters to you. XXXXXXX

Answered by Dr. Rakesh Madhyastha (2 hours later)

Brief Answer:
absolute contraindication

Detailed Answer:
Hello

Absolute contraindication means that one should not use it.

Regards

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Above answer was peer-reviewed by : Dr. Arnab Banerjee