Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.
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Dear Martin,
I went to the cardiologist for a checkup last week, which I do every 3 months. Since my sugar had been on the high side for a long time, she told me to do something about it 3 months ago. I was very proud that I had reduced the sugar from 168(9.2) to 125(7.0). But she paid no attention to that at all.
The laboratory had also measured the Creatinine, which she said was shockingly high, namely 1.91. I immediately had to see a specialist, who also looked doubtfully at the figures and at my medication list. I had to go off Metformin and Irbesartan. I was given 2 replacements whose names they refused to name and my kidneys were looked at with an ultrasound machine on a black and white screen with an image that was even worse than the image I had on my TV when I was 50 years ago. tried to watch a German channel.
I'm very confused now because I had Irbesartan for high blood pressure and it was said to be good for the kidneys. According to the doctor there are 5 phases and I am in phase 4 and will have to go on dialysis in a year. I'm very insecure now, because I feel fine otherwise.
My drug list is as follows:
Controloc 40 mg, Nifidipine 20 mg, Lanoxin 0,125 mg, Wafarin 2,5 mg, Tamsulosin Hydrochloride 0,4 mg, Metformin 2000 mg (withdrawn), Irbesartan 150 mg (withdrawn) plus 2 unknown replacement drugs.
I am 76 years old, 1,65 tall and weigh 66 kg.
- Is the doctor right and is it dramatic?
- Do I need to prepare for Dialysis?
- What to do with medicines?
- Should I get a second opinion?
Lab result:
Sugar 125mg/dl (70-110)
Creatinine 1.91mg/dl (0.7-1.6)
HB A1C (DM patients:Good control<7.0%) 6.2 % (4-8)
Many thanks in advance for your attention and advice.
Regards,
H
*****
Dear h,
Never take medicine without knowing what it contains. Tell that to the doctor too.
In the elderly, creatinine alone is not a good measure of kidney function because of the slow reduction in muscle mass, with a lot of creatinine being released into the blood.
The default is GFR measurement. The best way to measure that is in 24-hour urine (Urine Creatinine Clearance).
It can also be calculated from blood values, but that is less accurate.
You should also have BUN (Blood Urea Nitrogen) measured. That is a much better indicator than Creatinine for kidney function. That and the GFR are a good test to determine kidney function. BUN may be elevated in the elderly.
Until 60 it doesn't say much. That is why the Bun/Creat ratio is used, which should not exceed 20. Normally 1-10.
There are indeed 5 stages for kidney failure. Phase 5 is the highest, but that absolutely does not mean that you have to go on dialysis. Those are just a few. So for now I wouldn't worry too much.
Furthermore, I would go back to the old medication, but without lanoxin. That's pure poison. Lower the metformin to 1500 mg. In severe renal failure, metformin can lead to lactose acidification (lactic acidosis), but this is extremely rare.
Metformin is one of the best and cheapest drugs for diabetes II. At the moment, however, there is a smear going on against the drug, because of the low price and because there are new, much more expensive drugs, which are generally no better. We see the same smear against, for example, omeprazole and pantoprazole.
Doctors who sow panic are often unsure of themselves and/or have too high a mortgage.
Whether the doctor is right, I can not say. I don't have enough data for that, but for now I doubt the verdict. Get a second opinion in another hospital. It doesn't have to be a private hospital.
If all goes well, I'd go for checkups a little less often. That creates "peace of mind" and can do absolutely no harm.
If you have been vaccinated for Covid, that could be the cause of the elevated Creatinine. I've seen that before. Drink enough!
All in all, don't panic.
Yours faithfully,
Dr. Maarten
Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information (see list at the top of the page).