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  dimanche 12 février 2023
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Hi, I am a 26 M Southeast Asian, non-diabetic, hypertensive. I had an AKI last year due to renal hypoperfusion secondary to dehydration which may have been aggravated by my anti-hypertensive medication (Candesartan 8 mg). I had a negative dipstick for protein during my hospitalization.

I recovered quickly after IV fluid administration and the doctors switched me to a beta-blocker (carvedilol 12.5mg) since they discovered I had tachycardia.

This January, my doctor and I decided to switch back to candesartan since I had episodes of extreme fatigue with carvedilol. During this time, my doctor requested labs and we discovered that I had a high FT4 and a UACR of 10 mg/mmol (microalbuminuria).

My serum creatinine ranges from 74-88 umol/L which was my usual levels prior to the AKI. My latest EGFR is 123 with serum creatinine of 74 umol/L. My heart rate is usually 80-90s. Occasionally 100s.

My doctor has referred me to an endocrinologist and I was wondering if I should be referred to a nephrologist too. Could my high UACR be due to residual damage from the AKI or from my high thyroid hormone levels?

Would greatly appreciate to hear your opinion. Thanks!
Accepted Answer
Hello,

That level of microalbuminuria could be due to tubular injury/dysfunction or low-grade glomerular injury on account of your background of hypertension. Fortunately, that is a very small level of albuminuria which can easily be managed with blood pressure control and use of angiotensin receptor blocker (like candesartan) and possibly even an SGLT2 inhibitors. It was very reasonable to hold his medication while you experienced an AKI episode however. Following its resolution, in general, the ARB could safely be restarted to manage your blood pressure provided the creatinine remains stable when doing so. We generally hold ARBs such as candesartan during acute illness as they are considered a "sick day medication". Thyroid disturbance usually does not contribute to proteinuria.

I can only base my opinion on the information provided and your health-care provider might arrive at different conclusions once you have provided an entire history and had a physical examination performed. As always, this forum provides general medical information only and is limited to educational use only. Please discuss the above remarks with your health-care provider.

Dr. Jordan Weinstein, MD
Division of Nephrology, St. Michael's Hospital
Associate Professor of Medicine
University of Toronto
Accepted Answer
Hello,

That level of microalbuminuria could be due to tubular injury/dysfunction or low-grade glomerular injury on account of your background of hypertension. Fortunately, that is a very small level of albuminuria which can easily be managed with blood pressure control and use of angiotensin receptor blocker (like candesartan) and possibly even an SGLT2 inhibitors. It was very reasonable to hold his medication while you experienced an AKI episode however. Following its resolution, in general, the ARB could safely be restarted to manage your blood pressure provided the creatinine remains stable when doing so. We generally hold ARBs such as candesartan during acute illness as they are considered a "sick day medication". Thyroid disturbance usually does not contribute to proteinuria.

I can only base my opinion on the information provided and your health-care provider might arrive at different conclusions once you have provided an entire history and had a physical examination performed. As always, this forum provides general medical information only and is limited to educational use only. Please discuss the above remarks with your health-care provider.

Dr. Jordan Weinstein, MD
Division of Nephrology, St. Michael's Hospital
Associate Professor of Medicine
University of Toronto
Jordan Weinstein selected the reply #2726 as the answer for this post — 1 year ago
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