What Do My Lab Test Reports Indicate?

Posted on Tue, 1 Dec 2015

Tue, 1 Dec 2015 Answered on

Sun, 3 Jan 2016 Last reviewed on

Question :
Followup Question to Dr. XXXXXXX Madhyastha
Nephrologist

Dear Sir,

with your help my dad is doing good and latest reports are attached. please review and give your opinion on the whether i continue Orofer XT or not

Answered by Dr. Rakesh Madhyastha (16 hours later)

Brief Answer:
Make orofer alternate days

Detailed Answer:
Hello

Thanks for the query

I have gone through the reports attached and I recommend the following things

1. I recommend ACE/ARB tablet dose to be increased further as there is protein loss in urine . I usually start TAB ENALAPRIL at 2.5 mg a day and slowly start increasing it at every visit. I strike a balance between loss of protein, serum potassium and blood pressure ( avoiding hypotension). Time and again it has been proven that ACE/ARB group of drugs are the best drugs to retard the progression of kidney disease. Please speak to your doctor about my suggestion

2. One can decide whether or not to stop OROFER XT based on serum iron studies and not just on hemoglobin values. I suggest you to get Serum ferritin and transferrin saturation next time. For now I recommend taking Orofer XT tablets every alternate day. Stopping it might cause drop in hemoglobin

I hope I was of help, please get back to me for any further queries

Regards

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

Follow up: Dr. Rakesh Madhyastha (6 hours later)

Sure Sir,

will get back to you after reports.

I have one query

this whole episode of Kidney injury started when my father was on Tab Metformin once it was stopped and my father shifted to Insulin his gastric episode has improved a lot and he is comfortably eating now.

so I doubt whether this is diabetic nephropathy or acute kidney injury due to Metformin use.

Answered by Dr. Rakesh Madhyastha (17 minutes later)

Brief Answer:
Not due to Metformin

Detailed Answer:
Hello

Thanks for getting back. Long standing diabetes is known to causes nephropathy in more than 40% of the diabetic patients. Metformin is contraindicated in patients with creat of more than 1.8 mg/dl because it causes acidosis. Metformin is not the cause for kidney injury.
Metformin can cause gastric intolerance in a few; otherwise it is a well tolerated drug in our day to day practice

Regards

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

Follow up: Dr. Rakesh Madhyastha (3 days later)

Sir

i take Savcar from Emcure which is costly however i am considering to take the below pill as substitute...can you please suggest whether it will be good or have any concerns ...

Revlamer from Sun [Sevelamer Hydrochloride]

Answered by Dr. Rakesh Madhyastha (18 hours later)

Brief Answer:
Can take Revalamer

Detailed Answer:
Hello
Thanks for getting back

You can go ahead and take Revlamer. Infact I write Revlamer to all my patients. It is a good drug from a reputed company

Regards

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

Follow up: Dr. Rakesh Madhyastha (2 days later)

sir,

what should be the dose of Orofer xt, you have advised it to take on alternate day but it should be taken twice a day or once a day?

Answered by Dr. Rakesh Madhyastha (19 hours later)

Brief Answer:
Based on Iron studies

Detailed Answer:
Hello

Thanks for the query

Like I said earlier the dosing of Orofer XT is based on whether or not Iron is deficient in the body. I suggest you to get Serum iron, Ferritin and serum transferrin saturation done.

In Chronic kidney disease it is slightly different from general population, in CKD we aim the hemoglobin to be between 10 to 11.5 mg/dl.

Ideally Orofex Xt is taken twice a day, however in terms of good iron stores, hemoglobin in CKD is maintained by giving Erythropoetin injections. Regular intake of iron tablets in the presence of good iron stores leads to side effects including permanent liver damage.

Regards

Above answer was peer-reviewed by : Dr. Raju A.T