Doctors Lounge - Nephrology Answers
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Forum Name: Miscellaneous Nephrology Topics
|shorty1773 - Fri Oct 01, 2004 6:29 pm||
I am 36 yrs old, female, mother of 3. History of gestational diabetes with all pregnancies. My last baby was born on Feb 6, 2004 at 29 weeks gestation. Doing remarkably well! The doctors brought her into the world early due to my severe pre-eclampsia (180/110). My kidneys were excreting 3.5 grams of protein the last 2 days of my pregnancy). I am chronic hypertensive. I am currently taking several medications (Tenoretic 50/25), Lisinopril (Zestril 40 mg), Metformin (500 mg 2x daily). My Nephrologist put me in Metformin in August because my fasting bs was 120. My primary dr said that last year my fasting bs was 87. I am overweight, 5' 1", 165 lbs.
Anyway, I continued to show protein in my urine after giving birth. They finally got the right medicines to control my bp (now is 110/70 to 104/60!) My last 24 hr urine result came back at approximately 300 mg protein/24 hrs. I was taking my Lisinopril incorrectly..originally she (dr) had me on 20 mg, then switched me to 40 mg (she didn't tell me to take 40 mg at the same time...I took 20 mg in the AM and 20 mg in the evening). The pharmacy told me to take 40 mg only once now that I have the 40 mg single pill. I don't know if that had any affect on the 24 hr test result for protein....I was taking it incorrectly when the last test was done. However, since I have been taking the Lisinopril, the protein count has been going down....
Now, she wants to do a kidney biopsy on me. She told me that my kidneys are working 100%...all bloodwork is normal. My primary dr at my last visit (Aug 9) told me that the urine sample I gave him was negative of protein...my blood pressure was great (100/60) and that I was in great shape...lose weight and the problems will go away or greatly improve. I'm trying.
I am scared to go back to the Nephrologist. My primary says that she sounds aggressive and that 300 mg or so protein in 24 hrs in micro and is not a cause for alarm. He advised me against the kidney biopsy. I really don't want one....it has a lot of risks...is painful and requires an overnight stay in the hospital (which I can't afford to do...I've got 3 little girls and only my husband to help me)...no family lives in GA.
Based on what I have described above, would you recommend that I have the biopsy? The Nephrologist was afraid that I had diabetes for years and was undetected and now fears that this is causing the protein in my urine. My primary dr said that at last yrs annual chkup it was normal.
Any advise you can give me will be greatly appreciated!
Thank you so much for your time!
|Dr. Tamer Fouad - Sun Oct 03, 2004 1:17 am||
I understand your nephrologist's concern. However, since your urinary protein level is declining, I would prefer to put you on follow up. It would be advisable to get a biopsy done as soon as the protein levels increase again without an obvious cause (such as pre-eclampsia). I strongly recommend that you have this discussion with your nephrologist and tell her that you would prefer to delay the biopsy for now.
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