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Referring to your kidney tests, these are normal. A very low albumin in the urine is actually desirable.

Regarding your slightly high ALT, this might be due to your use of a statin medication. But there are many other causes of elevated ALT including viral infections.

Dr. Jordan Weinstein

Regarding the ultrasound, hopefully enlarged does not mean obstructed - where they might use a term like "hydronephrosis". If it does, that has to be addressed.

The urine the attached above suggests a modest but significant amount of proteinuria. An albumin to creatinine ratio would be more accurate but likely won't reveal much else.

The telmisartan might have contributed to a loss of eGFR but normally that will plateau and that drug class does have long-term benefits despite short term changes in GFR. This should be confirmed by watching the eGFR trend.

My original comments hold that there is likely primary cause of kidney disease (for example a type of glomerulonephritis). This can only be confirmed by a renal biopsy which is something that can be discussed with his nephrologist. I do not agree withe the statement that these findings are explained by "dehydration" as this should not cause an elevation in urinary protein unless the urine was simply extremely concentrated at the time. This can be assessed further with a urinary albumin to creatinine ratio which can accounts for the issue of urinary concentration.

Hello,

It is unlikely that uric acid elevation alone is causing kidney disease. In fact, it's more likely that reduced eGFR causes uric acid to accumulate and might lead to gout. I don't have enough information to comment on the nature of your brother's kidney disease but it is unusual that eGFR is fluctuating so widely (89 to 59). Was the drop from 89 to 59 coincidental with starting Telmisartan? Based on the limited information I have about his urine, he does have significant but not high grade proteinuria, which again does go along with a primary kidney disease. It would be important for your brother to have additional serologic tests in the blood to look for clues of the underlying cause for his kidney disease, an abdominal ultrasound and urine microscopic exam. With that information, we could comment further.

Dr. Jordan Weinstein

Hello,

eGFR is calculated directly from the creatinine. Therefore the same creatinine must reveal the same results for the eGFR. It is possible that the calculation was done incorrectly. Another possibility is related to your ethnic background. If you are black, you must multiply the answer by 20% to accommodate for the difference in the way creatinine is produced in black people versus non-black people in that case, you would multiply 1.2 times 59 Which would bring you closer to 70.

Dr. Jordan Weinstein

Hello,

Thank you for the detailed post.

Your symptoms are not necessarily a result of the ureterocele which might simply be an incidental finding. Your symptoms might be compatible with renal colic due to a kidney stone but it does not sound like you ever passed one or that one was ever detected on imaging. The ultrasound comment of minimal fullness suggests some degree of obstruction which might contribute to pain but usually it would be more obvious on imaging. A lasix renal scan might be helpful to see if there is any element of obstruction there. Alternatively, you might consider being investigated for other causes of pain rather than urologic. Have you had any gastrointestinal work up?

Dr. Jordan Weinstein

Hello,

• What was the cause of your solitary kidney from age 35?
  
• Do you have any other health conditions?
  
• Do you take medication including supplements?
  
• What is your blood pressure?
  
• What is your ethnic background?
  
• Do you have family history of kidney disease?
  

Dr. Jordan Weinstein