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  Monday, 30 March 2020
  4 Replies
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Hello, we were told in January that my husband was developing stage 1 KFD due to Hypertension. We asked about a specialists and dietician and was told by his PCP that a dietician wouldn’t be approved at this stage and she would refer him to a Nephrologist when she thought it was necessary. He was put on BP medication and told to watch his sodium intake.

Last week he was told he has Stage 3 KFD by the same PCP. I am confused and concerned. Does KFD advance that quickly? Did he misunderstand her on this 2nd visit? And still no referral to either a dietician or Nephrologist.

Now his PCP office is closed due to the Coronavirus and I cant get any answers. I uploaded both labs. I would appreciate any input. I don’t think we can wait until they reopen to figure this out. Especially if it jumped that quickly.

He is 48 yo 6’0” 193
Thank you

For some reason the attachments didn't work. Please send to my hospital email: [email protected]

Dr. Jordan Weinstein
Thank you for sending.

Kidney function can fluctuate in short periods of time, particularly related to medication use. I notice from the lab report that your husband has a low potassium. This could be indicative of him taking a diuretic such as hydrochlorothiazide for example. In that case, blood pressure and kidney function can fluctuate with use of this medication and before becoming too alarmed, I would repeat the creatinine to see if it is a persistent change (as an aside, in order to calculate your husband's kidney function more accurately can you tell me whether he is black?). I do also note that there is protein in the urine which if persistent does, by itself, indicate that he does have a form of chronic kidney disease.

It would be very helpful if you provided a list of his medication below. It also appears as though he has slightly elevated blood sugar. Is he known to be diabetic and is he on medication for that?

A referral to a nephrologist would be wise, but at a minimum I recommend a repeat of his urinary protein and kidney function as well as an abdominal ultrasound.

Dr. Jordan Weinstein
4 years ago
He is Caucasian. He was told he was pre-diabetic 7 years ago. No medication.

He is on 5 different medications all of which have a either a severe drug interaction warning or a moderate drug interaction warning. I know this is sometimes unavoidable but he has been having a lot of muscle spasms the last couple of weeks.

Losartan Potassium 100mg (began Jan 3rd)
Triamterene-HCTZ 37.5-25mg (began Feb 4th)
Potassium CL ER 10meq (began March 5th)

Amlodipine Besylate 10mg (began Jan 3rd)
Metoprolol Succ ER 50mg (began March 5th)

Again Thank You for taking the time to help. It is very much appreciated!
Very interesting.

Because his potassium level is low on a potassium sparing diuretic (triamterene) as well as an angiotensin receptor blocker (losartan) and a potassium supplement, I would strongly consider investigating for secondary hyertension, especially elevated aldosetrone levels because often hyperaldosteronism requires different medications which can be highly effective and perhaps reduce other medication requirement. In some cases, surgical correction of (benign) adrenal growths can dramatically improve blood pressure as well. There are other causes of secondary hypertension and I most definitely recommend referral to a nephrologist to assess this further.

Dr. Jordan Weinstein
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