BP/Fishoil/% Kidney Function

[Guest guest]

I've been a member of the group for 11 days now and can't drag myself

away from the site - trying to absorb too much about IGAN as pos.

A few questions to you all

1. BP: My resting BP was 150/80 at the end of November (usually

150/90) and i started on Enalapril 5mg per day yesterday - at my

request, to try and reduce. Firstly, what level am i trying to

achieve? Secondly, i have read that ACE inhibitors such as Enalapril

will not tend to lower BP more than 10 or so points. How do i gain a

reduction beyond this?

2. Fishoil: I know the benefits of this are inconclusive with the

Mayo center providing the main trial, however, is anyone aware of any

other trials? Also, i understand that the Mayo centre ran a second

trial using 1/3rd of the initial conducted dosage of 12grm per day,

therefore 4grm per day - can someone confirm and expand on this?

3. Kidney Function: I read on various postings that % of kidney

function is quoted by neph's. How can one calculate the percentage of

kidney function?

My best wishes to everyone for the New Year

(from the Channel Islands)

[Guest guest]

Replies in context below.

--Pierre

BP/Fishoil/% Kidney Function

> I've been a member of the group for 11 days now and can't drag myself

> away from the site - trying to absorb too much about IGAN as pos.

>

> A few questions to you all

>

> 1. BP: My resting BP was 150/80 at the end of November (usually

> 150/90) and i started on Enalapril 5mg per day yesterday - at my

> request, to try and reduce. Firstly, what level am i trying to

> achieve? Secondly, i have read that ACE inhibitors such as Enalapril

> will not tend to lower BP more than 10 or so points. How do i gain a

> reduction beyond this?

The general goal should be in the neighbourhood of 130/85 or lower. There is

no blood pressure drug really that will lower BP by more than 10 points, if

that. Sometimes, with drugs like ACEI's which work on the very system that

the kidneys use to raise BP in the first place, the reduction can be more.

But, in general, you will be lucky if it is even 10 points (more often 5 to

8 point reduction or so). This is why most kidney patients end up on more

than one drug eventually, sometimes three or more. What else can you do?

Well, eliminating the use of table salt might help - just don't replace it

with a potassium-based salt substitute (that's dangerous, especially when

combined with an ACE inhibitor). Regular exercise helps keep BP low too.

Keep in mind though that the level of BP you have is not an immediate

threat. So, there is time to lower it, and with drugs, a gradual approach is

always wise. Also, just table salt. Don't eliminate all sodium without

consulting your doctor first. If that makes no difference after 2 or 3

weeks, then it probably won't work for you, and your doctor will have to

raise your dosage of enalapril to the maximum dose. After a while, if that

doesn't work, he will add a second drug - like a diurectic or a calcium

channel blocker.

> 2. Fishoil: I know the benefits of this are inconclusive with the

> Mayo center providing the main trial, however, is anyone aware of any

> other trials? Also, i understand that the Mayo centre ran a second

> trial using 1/3rd of the initial conducted dosage of 12grm per day,

> therefore 4grm per day - can someone confirm and expand on this?

I think the report of that trial is in the BOOKMARKS section (Dr. Donadio).

There were some smaller fish oil trials somewhere in Europe that yielded

opposite results from Dr. Donadio's trial. I don't have them on hand, but

when I get time, I'll have a look (unless someone else has the answer).

> 3. Kidney Function: I read on various postings that % of kidney

> function is quoted by neph's. How can one calculate the percentage of

> kidney function?

% kidney function is really just a rough estimate for the patient's sake,

because we ask for it, and it's easy to understand. It is really nothing

more than a guesstimate that nephrologists can do based on their experience

(when they look at your serum creatinine and other things). It's not a

really accurate calculation at all. What really tells the tale is

" creatinine clearance " , from a 24 hour urine, or a calculation of

" glomerular filtration rate (GFR) " . There are various methods to calculate

this - the latest one you can find on www.nephron.com at

http://nephron.com/cgi-bin/MDRDSI.cgi

The most current concept is a calculated GFR that doesn't require a 24 hour

urine collection.

By the time serum creatinine is elevated at all, about 50% kidney function

has usually already been lost. But you can stay at 50% for years and years

after that. I did.

>

> My best wishes to everyone for the New Year

Same.

>

> (from the Channel Islands)

>

I'm pretty sure you're our first member from the Channel Islands : )

Pierre