Managing GFR at 43: Insights Needed
I am a 58-year-old assigned female at birth (AFAB) who has not undergone hormone therapy or surgical interventions. My medical history includes congestive heart failure (CHF) with a preserved ejection fraction, lymphedema, and poorly controlled diabetes, which I am currently addressing. Additionally, I have experienced issues with kidney stones larger than 1 cm, pulmonary embolisms, chronic low potassium levels (hypokalemia), avoidant/restrictive food intake disorder (ARFID), and was diagnosed with autism in the 1990s. My current medication regimen includes insulin, torsemide, triamterene, eplerenone, oxybutynin, levothyroxine, midodrine, and apixaban. I occasionally consume light amounts of alcohol, but I haven't done so for several months and have never used tobacco, though I do use cannabis and caffeine. Currently, I'm receiving antibiotics for a urinary tract infection. For the past five months, I've been experiencing pain in my lower left back. An ultrasound conducted four months ago did not reveal any kidney stones. I might undergo a right heart catheterization, but only if I can raise my potassium levels to at least 3.0, as I’m also dealing with a full-body pain. As of two days ago, my potassium was measured at 2.6, along with cramping symptoms; however, this was dismissed by both the emergency department and medical-surgical staff as not warranting significant intervention. I expect my potassium levels to decline further in the coming days since the infusion clinic has canceled my session. Notably, my creatinine level has increased from a usual baseline of approximately 1.00 to 1.43, while my GFR has dropped from around 60 to 43. These alterations are new to me, and until now, I hadn't been diagnosed with chronic kidney disease (CKD), so I suspect acute kidney injury (AKI). I have two inquiries regarding my situation: 1. Aside from reducing the use of diuretics, are there other actions I should consider taking in light of these results? 2. I have a standing order for a basic metabolic panel (BMP) to monitor potassium weekly. Should I arrange for the test to be redone, and if so, what would be the appropriate timeline for that, or should I just wait until Tuesday? I appreciate any advice or insights you could provide regarding these matters.
Answers (1)
6/26/2025, 2:31:00 PM
OpenHealth AI
It sounds like you are navigating a complex and concerning situation with your kidney function, potassium levels, and overall health. Here's a structured approach addressing your inquiries:
Main Points
- Consider reducing diuretic use while implementing other supportive measures for kidney health.
- Regular potassium monitoring is essential given your low potassium levels, and retesting should be considered promptly.
Explanation
Your GFR (Glomerular Filtration Rate) of 43 indicates potential kidney impairment, which can arise from acute kidney injury (AKI) or chronic conditions like CKD (Chronic Kidney Disease). The recent elevation in your creatinine level and low potassium are essential indicators to monitor closely. Since you have a complex medical history involving diabetes, heart failure, and medication management, every change can significantly impact your health.
Diuretics such as torsemide may contribute to your low potassium levels, and potassium-sparing medications (like triamterene and eplerenone) can sometimes help mitigate issues, but managing your fluid status is crucial.
Next Steps
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Medication Review:
- Discuss with your healthcare provider the possibility of adjusting or closely monitoring your diuretics. Sometimes, reducing diuretic doses can improve potassium levels while ensuring fluid management remains effective.
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Potassium Levels:
- Retest Potassium: Given your potassium level of 2.6 and recent symptoms of cramping, arranging for a repeat test sooner than Tuesday may be warranted. Aim for testing in 1-3 days if symptoms persist or worsen. Monitoring closely is key to preventing severe complications.
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Dietary Adjustments:
- Focus on potassium-rich foods (if your potassium levels are stable enough):
- Bananas, oranges, potatoes, spinach, and avocados can be helpful, but ensure these align with your dietary management in light of your ARFID and diabetes.
- Stay hydrated but monitor your fluid intake according to your heart failure and kidney needs.
- Focus on potassium-rich foods (if your potassium levels are stable enough):
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Symptom Tracking:
- Keep a symptom diary noting any changes in your lower back pain, cramping, and overall well-being. This can help identify patterns and inform discussions with your healthcare team.
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Education and Support:
- Familiarize yourself with the signs of worsening kidney function (e.g., increased swelling, significant fatigue, changes in urine output) so you can act quickly if needed.
Final Thoughts
I encourage you to maintain open communication with your healthcare providers regarding these issues. Your proactive approach in managing your condition is commendable. Let's focus on these priority actions and reassess in a few days. If you have more questions or need further assistance, feel free to reach out.
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