Nephrologist (kidney doctor) needed

[NewGuy]

I live in Pattaya and have been to hospitals all over Chonburi and in Bangkok. Costs are an issue. As long as English is handled well by a doctor I have no problem with government hospitals and long waits.

 

I my latest test results showed eGFR (non-African-American) at 47.0. My RBC Count, Hemoglobin (hb) and Hematacrit (Hct) readings were all low. My diabetes doctor told me I had anemia, my CKD was Stage 3. I was told to avoid potassium foods like bananas, nuts, and oatmeal, so museli, almost daily, is out.

 

My insurance company knows I’m diabetic and has a history of denying related coverage.

 

What doctor choices are good for me? Please Sheryl, your knowledge and experience are sorely needed. I’ve got a gloomy attitude in case you didn’t guess.

[QuantumQuandry]

If you don't mind me asking, do you have a history of low eGFR (or proteinuria/albuminuria)?

 

I know mine jumps around all over the place.  Mine has literally been as low as 27 and then 104 two months later.

[NewGuy]

QuantumQuandry, here are some results:

 

 

2023-11-10 eFGR: 52.5 comment: stage 3

2023-04-15 eFGR: 58.6 comment: stage 3, RBC okay, Hb, Hct - both low

2022-10-22 eFGR: 84.5 comment: stage 2, RBC, Hb, Hct - all low

2022-04-22 eFGR: 71.9 comment stage 2, RBC, Hb, Hct - all low

2021-10-22 eFGR: 76.5 comment stage 2, RBC, Hb, Hct - all okay

2021-04 ???

2020-10-12 eFGR: 57.6 no comment, RBC, Hb, Hct - all low

 

i’d be glad to provide other readings, if you want any.

 

cheers

 

[Sheryl]

The eFGR is just a calculation based on creatnine level and age, sex, and body size.

 

Thai labs (even in hospitals) often fail to adequately account for age and size so I would look more at your creatnine than at your eFGR (note that the "e" means "estimated"). And make sure creatnine is measured when adequately hydrated as dehydration wil increase it. There is no need to fast before a creatnine test.

 

@NewGuy see Prof.Dr. Khajohn Tiranathanagul  at Chulalongkorn after hours clinic

 

https://chulalongkornhospital.go.th/specialclinics/

 

He is there on Sunday mornings and Thursday evenings (start from 4 PM onward).  3rd floor of the Phor Por Ror building which is large highrise on the corner of Rajadamri and Rama IV, directly connected by overhead walkway to both Silom MRT and Saladaeng BTS.

 

You have to make appointment first through the Call Center at least 1 day in advance 02-256-5193. They will give you an appointment number, make careful note of it.

 

And assuming you have not previously been a patient there, you need to start by going to the ground floor of the building to register and get a patient hospital card. Bring your passport, and show them your appointment number when you do as they will issue you both the hospital card and an appointment slip which you then show at the nurses' counter on the 3rd floor. Special Clinic starts issuing queue numbers at 4 PM.

 

The time of your appointment has little or nothing to do with when you will actually be seen. Be prepared for as much as a 5 hour wait and bring plenty of  reading material.

 

[QuantumQuandry]

1 hour ago, NewGuy said:

i’d be glad to provide other readings, if you want any.

 

Good to see you keeping up with it.  That's the main thing I was curious about, if it was an ongoing thing or a single reading.  I don't have any special medical expertise, like @Sheryl does.  But since mine has been in the danger zone, I have also been keeping up with it, as well as researching it pretty thoroughly.

 

Always advisable to see a doctor.  In my case, I went and got a test to see if there was protein and/or albumin in my urine (was cheap, iirc).  I have a fair bit of muscle mass so I am also going to get an alternate test done, soon, called Cystatin-C, that I gather is more reliable for larger individuals.  It's a bit more expensive at the local lab (1200) but might be cheaper at the government hospital.

 

My motto is...talk to a good doc but doesn't hurt to have as much info as you can, going in.

 

 

[Lacessit]

It may sound like a quack remedy; however, the OP might give fenugreek seed a try.

 

My eGFR was 55 a couple of years ago. After a course of fenugreek, I got it up to 82. It is now back at 62, after chemotherapy.

 

It's not palatable. I found the best way to consume it is by soaking a tablespoon of fenugreek in water overnight. Drink the water, and swallow the seed whole. Have a bit of mango or pineapple afterwards to take away the slightly bitter taste.

 

It's readily available on Lazada, not expensive.

 

The evidence for fenugreek is mixed. According to Wikipedia,

 

"Fenugreek dietary supplements are manufactured from powdered seeds into capsules, loose powders, teas, and liquid extracts in many countries.^[4][5] There is no high-quality evidence that these products have any clinical effectiveness.^[4][5]"

 

^{OTOH, Internationalscholarsjournals says:}

 

"Antioxidant properties: The antioxidants present in fenugreek seeds, such as polyphenols and flavonoids, help combat oxidative stress and inflammation. These processes are closely linked to kidney damage. By reducing oxidative stress and inflammation, fenugreek seeds may help protect the kidneys from further harm."

 

I can only relate my own experience.

[QuantumQuandry]

10 hours ago, Lacessit said:

the OP might give fenugreek seed a try.

 

N-acetylcysteine (NAC) is another one I have been looking at.  But like Fenugreek and several others, there is still somewhat limited evidence so far.

 

Omega-3 fatty acids (and making sure you aren't vitamin D deficient) seem to have the best evidence from what I can tell?  What do you think?

[Lacessit]

12 minutes ago, QuantumQuandry said:

 

N-acetylcysteine (NAC) is another one I have been looking at.  But like Fenugreek and several others, there is still somewhat limited evidence so far.

 

Omega-3 fatty acids (and making sure you aren't vitamin D deficient) seem to have the best evidence from what I can tell?  What do you think?

My haematologist (female ) said she was taking fenugreek to improve lactation while she was breast-feeding twins.

 

Obviously, it's not entirely rejected by the medical profession.

 

The real problem with many of these compounds is no double blind, randomized studies of statistically significant control groups and subject groups, in well-defined age brackets and health conditions.

 

Hence a lot of anecdotal evidence, just as my first post is.

[scubascuba3]

My Creatinine and eGFRs look wrong from Lifecare Lab vs Red Cross, so I wouldn't trust a lab for those 

[QuantumQuandry]

7 hours ago, scubascuba3 said:

My Creatinine and eGFRs look wrong from Lifecare Lab vs Red Cross, so I wouldn't trust a lab for those 

 

That's concerning.  Can you elaborate a bit?  Which one you think is wrong and why?

[scubascuba3]

3 hours ago, QuantumQuandry said:

 

That's concerning.  Can you elaborate a bit?  Which one you think is wrong and why?

I get my Creatinine levels checked every 4 months from Red Cross, once a year or so i go to Lifecare lab for their package 4, their results for creatinine and eGFR are way different, so look inaccurate, i keep meaning to tell them but it will probably be ignored 

[Sheryl]

15 hours ago, scubascuba3 said:

I get my Creatinine levels checked every 4 months from Red Cross, once a year or so i go to Lifecare lab for their package 4, their results for creatinine and eGFR are way different, so look inaccurate, i keep meaning to tell them but it will probably be ignored 

As I have explained eGFR is not a blood test but a mathematical  calculation and labs can well vary in whether they accurately incorporate the age, sex    body size and ethnicity of the individual patient.

 

Creatnine level on the other hand is a direct measurement and any lab with properly calibrated equipment would be able to do it.

 

How different were these creatnine messures and was there any difference in fluid intake prior? 

[scubascuba3]

12 hours ago, Sheryl said:

As I have explained eGFR is not a blood test but a mathematical  calculation and labs can well vary in whether they accurately incorporate the age, sex    body size and ethnicity of the individual patient.

 

Creatnine level on the other hand is a direct measurement and any lab with properly calibrated equipment would be able to do it.

 

How different were these creatnine messures and was there any difference in fluid intake prior? 

Fluid probably the same, at Lifecare it's a fasting blood test

[QuantumQuandry]

6 minutes ago, scubascuba3 said:

Fluid probably the same, at Lifecare it's a fasting blood test

 

Interesting.  I actually use Lifecare and they have always told me there's no preparation or fasting necessary for Creatinine.  Was it fasted for another blood test, like FBS?

[scubascuba3]

16 minutes ago, QuantumQuandry said:

 

Interesting.  I actually use Lifecare and they have always told me there's no preparation or fasting necessary for Creatinine.  Was it fasted for another blood test, like FBS?

The only reason it's fasting is because package 4 includes blood sugar plus i include hba1c