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Forum Name: Diseases of the Aorta

Question: Fibromuscular dysplasia


 Leigh - Sat Apr 03, 2004 9:38 pm

I am a 43 year old white female and was diagnosed with FMD Feb of 2001. I have FMD in kidneys, one is very small and not functioning and the other has some disease also. My creatine level is 1.5. I had a stroke in 2002 and FMD was found in the interal carotid artery on the right side of the brain. i have a 70% narrowing there. 2003 found high homosystien levels and an anueryesm on the arota approximately 4cm. Drs. would like to do a bypass operation on the brain. They are watching the aorta also. My creatine levels have just recently (2 months) been at the 1.5. How high is too high and when shoudl something be done with the kidney. I am frightened about the bypass surgery and really have no troubling symptoms in the brain other than the stroke in 2002.
 Dr. Yasser Mokhtar - Sun Apr 04, 2004 11:18 am

User avatar Dear Leigh,

Thank you very much for using our website.

i assume, although you never mentioned it, that you are being treated for high blood pressure as your medication list shows.

A creatinine of 1.5 in itself does not mean that you have renal failure that needs dialysis if this is your question. You already have one non-functioning kidney, the best thing to protect the other kidney is to make sure that your blood pressure remains under very strict control and you avoid any thing (like medications) that could harm your remaining functioning kidney.

When is dialysis started? It differs from person to person. The kidney has a function of getting rid of excess fluid in our body in addition to many toxins that result from the body's metabolism as well. Once deemed not doing its job in a way that is going to jeopardize one's life, then dialysis is started and since dialysis is not the best thing to be having, now kidney transplant is available as the ultimate thing to do. About creatinine levels in the blood, it is a crude indication of kidney disease. According to the lab where you blood test is performed, it is considered abnormal if it is above 1.3-1.5, so your value of 1.5 might be slightly abnormal and might be on the higher side of normal. Usually, patients start dialysis with creatinine of 10 or above, all other things considered.

About carotid fmd, indications for intervention is to be symptomatic and you already had a stroke, it might happen again. Even in people who don't have fmd but have carotid stenosis 70% or more and become symptomatic (had a stroke, or a transient ischemic attack), need intervention.

Intervention in your case could be surgical and could be non-surgical by putting a stent in the affected segmen unless deemed not possible by your doctor. All procedures, whether minor or major, have their risks and benefits and one should weigh risks versus benefits and than takes the decision. If you don't want to have surgery, i don't think that anybody is going to force you to. If your doctor thinks that you need to have surgery, i would suggest that you visit with the surgeon who is giong to do the surgery and let him explain to you the benefits and risks of surgery in full and then think about it and take your decision. i don't think that your doctor wants to put you through all the risks of surgery unless he definitely thought you need it. And if you already met with the surgeon and had some concerns, take those concerns to your surgeon and let him answer all your questions and concerns.

And remember to always ask your doctor about other choices you might have.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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