CHF and kidney question

[lucky401]

Hi Folks,

I have a question that is directed more to my CHF and my kidneys than heart valve related but I was hoping that since your all so knowledgeable you might be able to give me some insights as to whether I need to be concerned about these kidney levels. I don't know maybe these readings are ok for people with CHF.

I just had my blood work checked and my kidney readings are all elevated. The BUN is 45, Creatinine 1.46, and BUN/creatinine ratio is 31. My GFR is 37 which is listed as low.

Are these results anything to be worried about? Also in the last two weeks I have gained some weight and noticed my abdomen has gotten larger. I took a lasek and lost 2 1/2 pounds in one day. I haven't taken anymore lasek because it causes my blood pressure to get very low - 78 over 48 is typical. My blood pressures run low around 90 over 60. I have also been very fatiqued and have difficulty when I walk on the tread mill which I do about 5 days a week for approximately 20 minutes a day.

Could these symptoms be developing due to the kidney readings? Do I need to go back to the CHF clinic. I am due to see my cardiologist in a approximately two weeks.

Thank you for your help.

 

[Jkm7]

Hi Barbara,
I don't know anything about the kidney levels but think it might be a good idea to speak with whichever doctor it was that ordered these blood tests be done. Maybe call that office?
Best Wishes.

 

[Ross]

Too-high BUN level
is called azotemia. Heart failure patients often have high BUN due to low blood flow to their kidneys. High BUN can also be caused by heart attack, intestinal bleeding, feeding by stomach tube, dehydration, high stress, or kidney failure
Too-low BUN level
is seen in liver failure, malnutrition, and pregnancy; or when you drink waaay too many fluids or get too much IV fluid at Club Med
You should be tested for BUN if you have heart failure, or take diuretics or ACE inhibitors, especially if changing dose. Urea nitrogen is a waste product caused by the way our bodies use proteins. Urea is formed by the liver and carried by the blood to the kidneys to be eliminated. Because urea is eliminated by the kidneys, measuring how much urea remains in the blood is one way to check kidney function - thus the BUN test.
BUN can go up if you get too "dried out" from high diuretic doses, because then you don't have enough fluid inside you to properly get rid of waste products. Low blood flow from heart failure, and ACE inhibitor and beta-blocker use are two other reasons BUN goes up.
Keep in mind that many things can cause BUN changes, so creatinine is considered a more precise way to test kidney funtion. Normal range for BUN is:

Men: 8 to 22 mg/dl
Women: slightly lower values than men
Pregnant women: values go down by about 25%
Elderly people: values may be a little higher


If your BUN reaches 100 mg/dl, you may be in trouble


Creatinine
You should be tested for creatinine if you take an ACE inhibitor, beta-blocker, diuretic, or spironolactone (Aldactone). Measuring serum creatinine can spot kidney trouble. Creatinine is the waste product of creatine phosphate, which is found in skeletal muscle. As long as your muscle mass is pretty constant, your creatine level should be constant. Creatinine is eliminated only through the kidneys so when kidneys get weak, creatinine level goes up.
Normal creatinine range is:

Adult men: 0.6 to 1.3 mg/dl
Adult women: slightly lower than men due to less muscle mass
Children: 0.2 to 1.0 mg/dl


If your serum creatinine reaches 8 mg/dl, you may be in trouble

Smaller people will have lower levels since creatinine level is related to muscle mass. Serum creatinine is not changed by protein use or fluid intake. Creatinine levels rise and fall more slowly than BUN, so creatinine levels are a better way to check kidney function long-term.
Tests to measure serum creatinine, urine creatinine, and creatinine clearance are all used to test kidney function. Serum creatinine does not go up unless at least 50% of the kidney's nephrons are damaged. Creatinine level relates to the kidneys' loss of nephrons like this:

Creatinine levels versus kidney damage
Creatinine level Kidney's approximate nephron loss
0.6 to 1.5 mg up to 50% nephron loss possible
1.6 to 4.6 mg over 50% nephron loss possible
4.7 to 9.9 mg up to 75% nephron loss possible
over 10 mg 90% nephron loss possible, end-stage kidney disease

Creatinine Clearance
This is not a routine test - A creatinine clearance test compares serum creatinine to the amount of creatinine eliminated in urine during a given time period, usually 24 hours. To start this test, you empty your bladder and flush it. Then you get to collect all your urine during the next 24 hours - nothing like carrying around a bucket full of pee to further your social life, huh? <g> During the test period, one blood sample will be taken to measure serum creatinine. Then they can compare the amount in your blood to the amount passed in your urine.
Standard values are:

Adult men: 85 to 135 ml/minute
Adult women: 80 to 120 ml/minute
Pregnant women: 150 to 200 ml/minute
Elderly: values go down about 10% per decade after age 50


If your creatinine clearance approaches 10 ml/minute, dialysis may be necessary

http://www.chfpatients.com/tests/routine_tests.htm#creatinine_clearance

Considering CHF and diuretics, your pretty normal, though on the high side of things. You need to be monitored closely as you can see the dangers of going way too high above. Kidney failure could potentially be in the cards if allowed to go too far out of range. I have the same trouble and my results are very similiar to yours.

 

[briansmom]

Ross gave you (and me) very good information. My son recently had a problem with the artery feeding his kidney. On this go round his creatinine hit 8 and his creatinine clearance was only 14. They always make my son quit taking his ACE inhibitors when he is in kidney failure - this may or may not apply to you because his problem was a narrowing of the artery. I would definitely ask for another test the day before you are to see your cardio and maybe ask for a referral to a nephrologist if the creatinine remains high. Managing CHF gets a lot trickier if you also have kidney issues so I recommend you stay on top of it and make sure that it doesn't get worse.

 

[Debster]

This is so my mom too....she really has to watch these levels. In fact, she is retaining water and has had to up the potassium and lasix...so more blood tests while this is going on. Her kidneys took a big time hit before surgery...best wishes to you!!! Deb

 

[Ross]

With my aneursym rupture, I had complete renal failure. That's hit 1. When I had my valve replaced, that was hit 2 on the kidneys. Other organs in the body will not put up with surgical abuse. I've had too many major hits and I'm told that I'm in a race to see what fails first, lungs, heart or kidneys.

All I can say is, stay on top of where you are and get copies of all tests that you've had.

 

[lucky401]

Thank you Ross for all your information - it was very helpful. I am seeing my primary today and am going to ask him if he thinks I need to see a kidney doctor. I looked at all my blood work for the last year and each time I had blood work done the numbers have gotten worse and the ones I posted are the most recent from a week ago. So I do see a trend towards a possible problem. I am glad to hear the numbers aren't that bad but want to keep things under control.

Thank you.

Barb

 

[skeptic49]

Whew! A lot of information there, Dr. Ross...thanks. I've had my kidney related issues so the heads up is valuable.

Jim

 

[lucky401]

Hi Folks,

Just thought I would give you an update. Since I wrote the post about my kidney function tests I have been in the hospital with an acute infection of the kidney. I had an appointment with my primary to go over the kidney function tests and when I got there they said I had a 102 fever - I was at work all day was cold all day and shivering but it never ocurred to me I had a fever. My doctor said he believed I had a kidney infection and sent me to the hospital. My blood pressure was 75 or 35 when I got to the hospital. So I spent 5 days in the hospital on antibiotic IVs however they had to stop all my heart medications due to dehydration etc. I see my cardiologist in 2 weeks to go over getting started again with my CHF medication.

I got out 2 days ago and am back to work but feel really exhausted. Luckily they didn't have to send me home with an IV and I can take the antibiotics orally. Getting blood work every 3 days to determine how much antibiotic I need to take.

I never had kidney trouble before so this is a first for me. I just can't get over how fatiqued it makes you feel. Thank God it was caught before the infection got into the blood stream.

This last year has been a tough one since my heart surgery. I hope this is my last setback.

Barb

 

[Ross]

Yeah well don't go setting up a mail box at the hospital ICU.

 

[barbwil]

CHF and kidney

CHF and kidney

Barbara, for what it's worth I will relate my husband's experience with CHF and kidney failure.

He was doing very poorly locally in spite of my harping at the pcp and cardio so we finally took him to the CHF clinic at the Cleveland Clinic. He had been on atenolol for years and the doctor there said there were only two beta blockers that should be used for heart failure, those being coreg and toprol XL (I see you are on coreg so that is good.) They took him off Lasix and Aldactone and put him on Bumex instead which works much better to get rid of the fluid buildup. They also added Hydralazine. The doctor told him he would be feeling a lot better in two weeks on the new regime and sure enough he started feeling a lot better. He started there at 200 lbs and today weighed in at 166. He could barely bend his legs because of all the fluid.

His creatinine was 2.5; he is now in stage 3 kidney failure. He has 29% kidney function but our nephrologist said that at his age (85) he would only expect it to be at 50%, not 100% as we might expect. He has had to modify his life style due to the shortness of breath issues so he works a little, then sits and rests till he resumes activity. I think he hears me in his dreams saying, No, you can't have that, too much sodium in it; and remember you're not supposed to have more than 2 liters of fluid a day.

So, all of this to say that if the local docs aren't making any headway with your involved issues you should go to a larger teaching hospital for help. Too bad you are in eastern PA instead of the western area but there must be a good CHF clinic near you.

Wishing you all the best!

 

[lucky401]

Thank you Barb for all your information. I do go to a CHF clinic outside of Philadelphia and they really got my CHF under control.

Unfortunately since I got out of the hospital with the kidney infection my CHF has gotten worse and I spent Tuesday night at the hospital. My primary sent me to the ER because he could hear fluid in my lungs and I had gained 3 pounds over night. So anyway I am home now and back to work but taking lasik to get rid of the water and also walking a fine line with the kidney issues. I am still feeling fatiqued and see the cardiologist again next week to try and get my medications back in balance. Hopefully this will do the trick and I will be able to go back to my normal life. I am disgusted because before the kidney infection I was doing really well, walking a mile 5 days a week on the tread mill and feeling pretty well. Hopefully I will get back to my exercising and feeling well soon.