DEAR DR. COCKROACH: I have had low GFR readings, from 53 to 37 in the last 15 years. I am an 87 year old woman in good health. I do strength training and Pilates, and I am very active to walk my dog and make my own backyard. I had heart disease for 10 years without symptoms and echocardiograms are normal.
My cholesterol is around 180 and my blood pressure ranges from 137/68 to 150/75. I take lovastatin and lisinopril daily. My doctor does not care about my numbers, as long as there are no significant “spikes” or “falls” and he emphasizes the importance of drinking plenty of water. When I am extremely sore, I will take an Aleve pill, only once during a period of four to six weeks, as I know that NSAIDs are not good for the kidneys, especially with readings like mine. Sometimes I take an occasional Tylenol.
Am I doing everything I can to help me? I prefer not to take medication for my GFR, nor does my doctor recommend it. We monitor with frequent blood tests, but the last two readings four months apart were 37 and 41. – SE
ANSWER: Recent changes in the report of kidney function have caused concern in many of my own patients, as well as spine readers, about their kidneys. Renal function always decreases as we age (GFR refers to the glomerular filtration rate, which is a test used to check kidney function). In many cases, people can develop what is called stage 3 kidney failure as part of normal aging. What can be very important to observe is the rate of decline: since yours appears to have been reasonably stable over 15 years, the likelihood that you will need dialysis for the next 15 years, when you will be over 100 years old, is quite low.
Your doctor has prescribed a medicine to help your kidney function: lisinopril, which has been shown to protect your kidneys. Although it is most effective when the drop in kidney function is associated with loss of protein in the urine, which may or may not be your case.
Avoiding toxic kidney 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. It has been observed that the switch from animal protein to vegetable protein reduces the risk of progression of kidney disease. I do not recommend an ultra low protein diet, however.
DEAR DR. COCKROACH: My question is regarding cholesterol levels and whether a very high HDL can really 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 seems to be high because of a lot of good HDL. Although I eat healthy and exercise moderately for a 73-year-old woman, I assume that my body produces a high level of cholesterol and would like to know your opinion on this matter. – B.
ANSWER: In general, high levels of HDL cholesterol (think “H for healthy”) reduce the risk of heart attack. However, there are a small number of people with a genetic mutation in whom high levels of HDL cholesterol actually increase cardiac risk. This is only present in a small percentage of people with high HDL. People with high HDL and known heart disease should be evaluated by a specialist.
Your level of 102 is very likely to represent health, not disease. If your family history is favorable for heart disease, it is extremely unlikely that you need to worry about this high level of HDL.
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Dr. Roach regrets not being able to respond to individual letters, but will incorporate them in the column whenever possible. Readers can email questions to [email protected] or email 628 Virginia Dr., Orlando, FL 32803.
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