Guest guest Posted December 29, 2001 Report Share Posted December 29, 2001 Your comment would suggest that fish oil is a waste of time? > > > , > > > > > > I may be missing something or not thinking clearly today, but I'm > > not sure > > > what the creatinine number you give represents. At 78, it can't be > > mg/dl, > > > mmol/L. I doubt that it's in umol/L, because that would mean it's > > better > > > than normal. This makes me suspect that 78 is not serum creatinine, > > but > > > creatinine clearance. If so, that would be from a 24 hour urine > > collection > > > and expressed in ml/sec/m**2 (or something like that). Can you > > confirm that? > > > > > > Derrick already provided a good reply, so I'll just add a few > > points I can > > > think of. > > > > > > Cholesterol. Well, high is high, and the implications are the same > > as for > > > anyone else: increased risk of cardiovascular disease. > > > > > > Albumin: about normal. That's just a measure of good nutrition (in > > other > > > words, you're not malnourished from lack of protein - but not > > likely that > > > you would be anyway). > > > > > > Urea: Not sure what unit of measurement you're using, but either > > way, seems > > > not too bad. > > > > > > Both your blood pressure and your proteinuria could stand some > > significant > > > lowering, so the choice of an ACE inhibitor like enalapril is a > > good one > > > (although some might consider a newer one that only need be taken > > once a > > > day). ACEI's reduce both BP and proteinuria. Ramipril in particular > > has been > > > the subject of many clinical trials. Enalapril's effect doesn't > > really last > > > a full 24 hours, so, best taken twice daily. > > > > > > Fish oil and tonsillectomy: > > > > > > Well, I don't want to get into any arguments about these > > controversial > > > subjects (lots of belief as opposed to hard data), but... > > > > > > Fish oil is a tricky one. Trial results are considered conclusive > > by those > > > who look at only the Mayo clinic trial, and inconclusive by those > > who look > > > at the bigger picture. It's a toss up, really, as to whether it > > will help > > > with anything. I doubt fish oil will lower your proteinuria very > > much. Also, > > > while I know they say it's harmless, I've found that it's a little > > > unpredictable in terms of what it might do to your already high BP. > > In some, > > > it lowers BP, and others have reported increased BP (including > > myself). You > > > may have to decide for yourself on that one (with your neph's > > knowledge, of > > > course). Similarly, high dose vitamin E has been known to affect > > blood > > > pressure either way, or not at all. It's probably fine though. Some > > nephs > > > " prescribe " fish oil automatically, others not at all. Take your > > pick. > > > > > > Tonsillectomy. Your choice, depending on which web sites and > > studies you > > > believe. The evidence on that is not conclusive because it is based > > on > > > uncontrolled observational trials mostly on a specific homogeneous > > > population, and the results of which have not been reproduced. > > That's a red > > > flag for any clinician. Most nephrologists don't give it much > > credence. > > > Might be useful if you have recurring upper respiratory infections > > though, > > > or maybe not : ) > > > > > > Personally, I don't think your choice of trying fish oil first, and > > waiting > > > for 3 months before starting the ACE inhibitor is a good one. ACE > > inhibitors > > > have proven benefits, and if anything, I would start with that > > first and > > > then the fish oil. Nothing, but nothing, provides more benefit for > > IgAN than > > > good blood pressure control down to about 120/80. > > > > > > Also, keep in mind that a proteinuria like yours may settle down or > > vary up > > > and down on its own from one set of labs, no matter whether you're > > taking > > > fish oil or anything else. Only two things are proven to > > effectively lower > > > proteinuria (besides just time in some acute cases): (1) prednisone > > (but > > > yours isn't high enough yet in terms of risks vs benefits, although > > some > > > nephs might decide to try it), and (2) BP meds of the ACE inhibitor > > class, > > > the ARB class, and two specific calcium channel blockers, namely, > > diltiazem > > > and verapamil. > > > > > > I do wish there were more definite answers about fish oil, > > tonsillectomy and > > > vitamin E, but there just aren't any. I take vitamin E now (400 > > IU), as per > > > my nephs instructions, but it's not for the IgAN itself, but rather > > to help > > > with the cramps associated with more advanced renal failure. > > > > > > If you've been around groups like this one long enough, you start > > seeing > > > that some people don't progress quickly at all, no matter what they > > take or > > > don't take, and others take the fish oil and have their tonsils out > > and end > > > up on dialysis sooner rather than later. Again, I can't emphasize > > enough the > > > importance of good blood pressure control in all this, no matter > > which drug > > > or combination thereof it takes. > > > > > > Hope that doesn't muddle the waters too much : ) > > > > > > Pierre > > > > > > new member background info > > > > > > > > > > have changed from phf74 to paul1xa - cant believe the amount of > > paul > > > > 1's, 2's 503's etc in existence! > > > > Many thanks for your kind welcome comments. > > > > > > > > As briefly confirmed, i was diagnosed with iga by biopsy in 1997 > > (no > > > > crescents). At that time the consultant was professor lee (UK) and > > > > basically he said to continue leading my life as normal and made > > no > > > > further recommendations apart from attending annual checkups > > > > including 24hr urine and blood etc. He also said that there was no > > > > cure for iga and also that the condition was not hereditary - > > having > > > > completed an amount of basic research i now wonder whether both > > these > > > > statements are correct? Anyway, 4 years have gone by and mainly > > due > > > > to family responsibilities decided to find out more about this > > > > condition with a view to stabilising/reversing if possible - i am > > 40 > > > > years of age with three young children. > > > > > > > > Details as per 1/11/01: > > > > Proteinuria 24hr urine = 2grms (understand implications of high > > pro) > > > > Typical blood pressure = 155/90 ( " " " " " > > blood) > > > > Cholesterol = 8.3 (Unsure of implications if high) > > > > Creatinine = 78 (unsure of significance) > > > > Albumen = 38 (totally unsure of sign--) > > > > Urea = 4 (totally unsure of sign--) > > > > > > > > My limited research confirms the following: > > > > 1. I understand that some consultants might recommend a high > > intake > > > > of fish oil capsules (12 per day EPA 180/DHA 120 1grm and i vit E > > > > 500iu, as a matter of course. Some studies would appear to show > > > > excellent results with much reduced proteinuria over a 6mth > > period. > > > > > > > > ----- At an annual appointment last month i asked the opinion of > > the > > > > consultant regarding this. Basically, his thoughts were that > > studies > > > > were inconclusive and did not consider the above treatment to be > > > > worthwhile. I started the above dosages 4 weeks ago with the > > > > intention of seeing whether or not proteinuria will decrease. > > > > > > > > 2. Obviously high blood pressure is a recognised factor in > > > > accelerating the condition and the control of this by way of an > > ace > > > > inhibitor, such as Enalapril, is important. > > > > > > > > ----At the same appointment, he confirmed that it was probably a > > good > > > > idea to start on Enalapril (5mg). My thought is to allow a period > > of > > > > time, say 3 mths, in which to confirm whether or not the fish > > > > capsules are having the desired effect before starting on > > Enalapril. > > > > > > > > 3. Tonsillectomy would appear to stabilise or even reverse the > > > > condition in some studies. > > > > > > > > -----At the same appointment, i asked whether he would recommend > > this > > > > to which he replied that he was not aware of this procedure. He > > > > decided to ask a senior consultant (Ian Abbs) who apparently > > > > confirmed that this procedure might be carried out in advanced > > > > stages. My thoughts were why should one wait until the condition > > > > advances if there is evidence to show that an early tonsillectomy > > > > would be of benefit? > > > > > > > > Any comments on the above would be extremely welcome. You will > > > > realise that my knowledge of the condition is very basic and i > > look > > > > forward to learning more about the condition from you all and look > > > > forward to your responses. > > > > > > > > Happy Christmas and kind regards > > > > > > > > paul > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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