DEAR DR. DONOHUE: Will you answer some questions about kidney problems in a 50-year-old male who has mild diabetes and high blood pressure? He just lost 30 pounds of fluid that caused severe breathing problems. His breathing problem subsided. His doctors struggle to lower his blood pressure. His doctors want him to think about dialysis. If you start, do you ever get off it? How is the family checked for a match if a kidney transplant is needed? I am his older sister. He also has an older brother and a younger half-brother. I am so worried about him. — J.F.
ANSWER: Your brother has chronic kidney failure. The kidneys are our filtration stations, cleaning the blood of waste materials and excess fluid. A test called creatinine clearance gives a reliable estimate of how well the kidneys are filtering the blood. Values above 90 ml/min (1.5 ml/s) indicate normal function. When the clearance falls to between 30 and 59 (0.5 and 0.98), that person has a moderate decrease in kidney function. Anything lower is severe, and that’s the stage when dialysis or kidney transplant is considered.
Your brother’s fluid retention with the resulting breathing trouble is a reflection of his kidney malfunction.
High blood pressure can cause kidney damage, and it also can result from kidney damage. Medicines for improving his blood pressure are many, and his doctors will find the right one for him eventually. He might need a combination of blood pressure drugs. Diabetes also is involved in kidney injury.
If dialysis or transplant is suggested, your brother ought to jump at the offer. Dialysis is usually for life, unless the patient obtains a kidney transplant. Family members often are the best candidates for organ donation. Potential donors are tested for their closeness to the recipient’s genetic makeup. Being of the same blood type and having a close match to HLA antigens indicate better chances for the transplanted kidney not being rejected. HLA antigens are a group of proteins on a person’s cells. Improvements in medicines that control rejection have allowed for greater latitude in accepting organs for transplants. Your brother is lucky to have a sister like you.
DEAR DR. DONOHUE: Several months ago I wrote to you asking about a disease called Binswanger’s disease. My sister died of this disease, and I would like to learn more about it. — M.M.
ANSWER: Binswanger’s disease belongs to the family of conditions that cause dementia. Dementia is a decline in mental function. Alzheimer’s disease is the most common dementing illness. The cause of Binswanger’s is thought to result from blockages in small arteries supplying blood to the brain’s white matter. White matter consists of interconnecting cables that allow brain areas to communicate with each other.
In its early stages, Binswanger’s has few noticeable signs or symptoms, and its progress usually is slow. “Executive function” suffers the most in this kind of dementia. Executive function includes things like decision-making, planning, arriving at rational judgments and exhibiting appropriate behavior. Memory also is impaired, and affected people are quite confused.
No medicine cures Binswanger’s disease. Medicines used for Alzheimer’s disease often are prescribed for Binswanger patients.
DEAR DR. DONOHUE: I had a full examination with extensive bloodwork for insurance purposes. Everything was normal except for something called the sedimentation rate. Mine is 23, and the normal for a female is 20. I was accepted for insurance, but my husband thinks I need to see a doctor. Do I? I feel fine. Maybe you can be my doctor. — J.M.
ANSWER: The sedimentation rate, or sed rate, is not a high-tech test. A high reading signals inflammation in the body. Your value of 23 sounds no alarms. You don’t have to see a doctor about it. The insurance company wouldn’t have accepted you if this were a serious issue. It isn’t.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.