Dear Dr. Cockroach: I have had low GFR measurements in the range 53-37 for the last 15 years. I am an 87 year old healthy woman. I do strength training and Pilates, and I am very active in walking my dog and doing my yard work. I have been suffering from heart disease for 10 years and have no symptoms and my echocardiography is normal.
My cholesterol is about 180 and my blood pressure fluctuates from 137/68 to 150/75. I take rosuvastatin and lisinopril daily. My doctor doesn’t care about my number unless there are significant “spikes” or “drops”. And he emphasizes the importance of drinking plenty of water. I know that NSAIDs are not good for my kidneys, so I take Aleve tablets only once every 4-6 weeks when I have a lot of pain, especially when reading like me. I take Tylenol from time to time.
Am I doing everything I can to help myself? I don’t want to take GFR medication and my doctor doesn’t recommend it. We monitor it with frequent blood tests, and the last two measurements at 4-month intervals were 37 and 41. — — IF
Answer: Recent changes in the reporting of kidney function have made many of my own patients and column readers worried about their kidneys. Kidney function constantly declines as we get older. Often, people can develop so-called stage 3 renal failure as part of normal aging. A very important thing to note is the rate of decline. You appear to be fairly stable for 15 years, so it is quite likely that you will need dialysis for the next 15 years over 100 years old. Low.
Your doctor has medicines for you to help your kidney function: Lisinopril, which has been shown to protect your kidneys. However, it is most effective when decreased renal function is associated with loss of protein in the urine. This may or may not be your case.
It is important to avoid NSAIDs, including ibuprofen, which are the most common nephrotoxic drugs. The risk seems to be low once a month.
The only thing you haven’t mentioned is diet. Switching from animal protein to vegetable protein has been observed to reduce the risk of developing kidney disease. However, we do not recommend an ultra-low protein diet.
Dear Dr. Cockroach: My question is about cholesterol levels and whether very high HDL can actually be dangerous. My HDL is 102 and it’s always on the high side. My LDL is 119 and my triglyceride is 69. My total is 235. My total seems to be high due to the large amount of good HDL. I have a healthy diet and exercise moderately for a 73 year old woman, but I think my body produces high levels of cholesterol. We would appreciate your thoughts on this issue. — — B.
Answer: In general, high levels of HDL cholesterol (think of it as “H for health”) reduce the risk of a heart attack. However, few people have genetic mutations in which high levels of HDL cholesterol actually increase the risk of the heart. This is only seen in a few percent of people with high HDL. People with high HDL and known heart disease should be evaluated by a specialist.
Your level 102 is very likely to represent health, not illness. If your family history favors heart disease, it is very unlikely that you need to worry about this high level of HDL.
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