I had blood extracted for a series of tests on 4th March 2013 before seeing the nephrologist the following week. They were Renal Function Test, Liver Function Test, Complete Blood Count, Lipid Profile, Nutritional Anaemia and calcium-phosphate test. It was to be my first time consulting a nephrologist at the University Malaya Medical Centre.

I went to see the nephrologist on 11th march 2013. Serum creatine broke the 300 umol/L threshold to hit 301 umol/L. It was unsettling to see the creatinine slowly creeping up the scale. Dr Wong, the nephrologist, explained that at some point in time in the future, I will need dialysis. I am at a pre-dialysis stage and need to be prepared for it. He explained the two options available to me – peritoneal dialysis or hemodialysis.

For hemodialysis, I need to go to a hemodialysis centre where I will be hooked up to a machine to have the waste product in my blood filtered. Each session lasts about four hours and has to be done thrice weekly. For this method, I have to have to undergo a surgery to create a fistula for blood to be extracted dialysis and then returned.

In peritoneal dialysis, a catheter is used to fill the abdominal cavity with dialysis solution. The solution draws waste from the body using the membrane in the abdomen called peritoneum as a filter. The waste is then drained away through the same catheter. This procedure has to be repeated every six-hourly and can be done anywhere.

A Complete Blood Count was also done to check on my anemia. The figures looked horrible with most of the blood elements tested coming in below the average ranges. Serum calcium-phosphate test show that I am hypocalceamia or low blood calcium concentration. There is no treatment recommended at the moment and I had to go back to see him in another three months which coincides with my appointment at the Rehabilitation Medicine Clinic.

However, Dr Wong suggested that I start on Ketosteril again and gave me two boxes to start off. That supply will last me forty days at two tablets twice daily. I had stopped taking it after I developed itching. I have been taking it for one month now and have not experienced any allergic reaction so far.

My LDL level went up because I stopped taking Lipitor for three months to see if it was causing the urea level to go up. Apparently, it did not as urea level was still high. I have since gone back to 10mg daily. I hope the next blood test will show better results.

Renal and Liver Function tests and Lipid profile done on 4th March 2013.

Comparative renal function test, liver function test and lipid profile results for December 2012.

I had my blood extracted and a KUB (kidneys, ureters and bladder) ultrasound on 17 December at University of Malaya Medical Centre (UMMC) and went back to the Rehabilitation Medicine Clinic on 26 December for the review. Serum creatinine increased slightly but is not significant. However, urea is markedly elevated from 7.5 mmol/L in February 2012 to 9.3 mmol/L in June 2012 and to 10.7 mmol/L in December 2012. I suspect it could either be caused by Lipitor or the fish oil that I have been taking.

KUB Ultrasound Report for December 17, 2012

Findings
Both kidneys are increased in echogenicity.
Right kidney measures 9.6cm in bipolar length.
Left kidney is small in size measuring 7.7cm.
No calculi or hydronephrosis.
The bladder wall is trabeculated.

Impressions
1. Renal parenchymal disease.
2. Trabeculated bladder secondary to neurogenic bladder.

As for the KUB ultrasound. the findings showed no significant changes from the previous one done in November 2011. I am scheduled to see a nephrologist in March 2013 for a review of my kidneys with a renal function test and liver function test done prior to that. In view of this, I have unilaterally decided to stop taking Lipitor until then to see if it affects my serum urea level. Other than that, I am quite happy with the results of the blood tests and ultrasound of the kidneys and bladder.

Comparative renal function test, liver function test and lipid profile results.

Serum creatinine went up slightly but still within range. Urea level spiked from 7.5 mmol/L in February to 9.3 mmol/L. It must be the fried anchovies that I have been indulging on a little too much of late. Need to cut down on that together with spinach and oatmeal. Otherwise, the doctor was not too concerned with the results and scheduled me for the next check up in six months instead of the usual quarterly. The consultation at the uropathy clinic in March also did not see the urgency for me to get a urodynamic test done as the blood tests have shown that the condition of my kidneys have somewhat stabilised at current levels. All is well, for now, and this gives me some leeway to enjoy some durians and hawker food when I am in Penang later this week.