San Antonio Express-News (Sunday)
Is 87-year-old woman doing enough to protect kidneys?
Q: I have had low GFR readings ranging from 53 to 37 for the past 15 years. I’m an 87-yearold female in good health. I do strength training and Pilates, and am quite active walking my dog and doing my own yardwork. I’ve had heart disease for 10 years with no symptoms, and echocardiograms are normal.
My cholesterol runs around 180, and my blood pressure fluctuates from 137/68 to 150/ 75. I take lovastatin and lisinopril daily. My doctor is not concerned about my numbers as long as there are no significant “spikes” or “drops,” and he stresses the importance of drinking plenty of water. When I’m extremely sore I will take an Aleve tablet, only once during a four- to six-week period, as I know NSAIDs are not good for the kidneys, especially with readings like mine. I sometimes take Tylenol.
Am I doing all I can to help myself? I prefer not to take medication for my GFR, nor does my doctor recommend it. We monitor it with frequent bloodwork, but the past two readings four months apart were 37 and 41.
A: Recent changes in reporting kidney function have caused many of my own patients as well as readers of the column to be concerned about their kidneys. Kidney function always decreases as we get older. In many cases, people can develop what is called Stage 3 kidney failure as part of normal aging. What can be very important to look at is the rate of decline: Since yours seems to have been fairly stable over 15 years, the likelihood of you going on to need dialysis in the next 15 years, when you will be over 100, is quite low.
Your doctor has you on a medicine to help your kidney function: lisinopril, which has been shown to protect the kidneys. Although, it’s most effective when the drop in kidney function is associated with protein loss in the urine, which may or may not be the case in you.
Avoiding kidney-toxic drugs — of which NSAIDs, including ibuprofen, are the most common — is critical. One a month seems low risk to me.
The only thing you haven’t mentioned is diet. Switching from animal protein to plant-based protein has been observed to reduce risk of progression in kidney disease. I do not recommend an ultra-low-protein diet, however.
Q: My question is in regard to cholesterol levels and whether a very high HDL can actually be dangerous. My HDL is 102, and has always been on the high side. My LDL is 119 and triglycerides are 69. My total number is 235. My total number appears to be high because of a high amount of the good HDL. Although I am a healthy eater and do moderate exercise for a 73-year-old woman, I assume my body makes a high level of cholesterol and would appreciate your thoughts on this issue.
A: In general, high levels of HDL cholesterol (think “H for healthy”) reduce heart-attack risk. However, there are a small number of people with a genetic mutation in whom high levels of HDL cholesterol actually increase heart risk. This is present only in a few percent of people with high HDL. People with high HDL and known heart disease should be evaluated by an expert.
Your level of 102 is very likely to represent health, not disease. If your family history is favorable for heart disease, it’s extremely unlikely that you need to worry about this high level of HDL.
Q: I’d like to know what kind of damage to look out for after being a heavy drinker between the ages of 19 and 40, at which age the drinking slowed to a comparative trickle. I used to have many binge events plus regular consumption three to four nights a week and now have a couple of glasses on weekends. The data on alcoholrelated cancers seems to be everywhere. I’m concerned there’s little I can do to stop the
inevitable.
A: Deaths in the United States attributed to excess alcohol are estimated to be nearly 100,000 per year. Many are becuase of motor-vehicle accidents or other accidental deaths, but long-term alcohol use does increase the risk for some types of heart disease (especially heart failure), liver disease and cancers.
Looking at cancer in particular, women should be concerned about breast cancer, while both men and women should be concerned about cancers of the head and neck, as well as GI cancers (esophagus, stomach, pancreas, liver and colon). Once excess alcohol intake has ceased, the ongoing risk begins to decrease. Liver cancer, for example, is extremely rare unless cirrhosis is present, and the progression of liver disease to cirrhosis is greatly slowed or halted by stopping excess alcohol.
There are good screening programs for breast and colon cancer, and you should be meticulous in following those guidelines. I would advise you to choose the most aggressive screening guidelines when there is disagreement among experts. Regular dental visits will help identify any oral cavity cancers early. Stomach and pancreas cancers do not have well-validated screening programs, unfortunately.
Stopping alcohol entirely will further reduce your risk, even if only by a small amount.
Q: I’m an 80-year-old male in good health. I take medication for blood pressure and cholesterol (lisinopril, atenolol, spironolactone and rosuvastatin). My wife and I still enjoy sex, and I take 100 mg of sildenafil about one hour before we have sex. It doesn’t seem to give me the results I would like. Can I safely take a higher dose?
A: There are several causes of erectile dysfunction, and sometimes no particular cause is found.
Medications can be a forgotten cause of erectile dysfunction. Of all the medications you take, spironolactone is the most likely to be causing a problem with sexual function. In addition to its effects as a diuretic — which is probably why you are taking it — it blocks androgen receptors, and can cause breast development in men, breast pain in women, decreased libido in both men and women and erectile dysfunction in men. It would be worth discussing alternatives with your doctor. Atenolol, a beta blocker, is a less-common potential cause.
The maximum dose of sildenafil (Viagra) is 100 milligrams. However, one hour may not be long enough for the drug to reach its peak effect. Be sure to take this medicine on an empty stomach and try giving it two or three hours to get fully absorbed. My experience is that this is a much more effective way to take the medication.