Day 58: Alarm Up!

It was rather a busy week for me doing blood tests and consulting with my nephrologist. My serum creatinine level results show an increasing trend contrary to what was expected. And there is a need to identify what is causing it.

My usual weekly lab tests include

1. Creatinine - indicator of kidney function; an elevated creatinine level signifies impaired kidney function
2. Complete Blood Count - used to evaluate overall health and detect a wide range of disorders; abnormal increase/decrease in cell counts indicate that there is an underlying medical condition that calls for further evaluation 
3. BUN(Blood Urea Nitrogen) - measures the amount of nitrogen in the blood that comes from the waste product urea which is passed out of the body via urine; if kidneys do not remove urea normally, BUN level rises
4. Lipid Profile - measures levels of lipids/fats, including cholesterol and triglycerides; it assess risk of developing cardiovascular disease or to monitor its treatment
5. FBS(Fasting Blood Sugar) - indicates the amount of glucose/sugar present in the blood; levels outside the normal range may be an indicator of a medical condition, diabetes in particular  
6. Urinalysis - checks different components of urine, a waste product produced by the kidneys; minerals, fluids, and other substances from blood are passed in the urine; what you eat, drink, how much you exercise and how well your kidneys work can affect what is in the urine; it helps find causes of symptoms of health problems one may have
7. Hemoglibin A1C - diagnoses Type 1/Type 2 diabetes; gauges how well diabetes is managed; reflects the average blood sugar level for the past 2 - 3 months; the poorer blood sugar control, the higher risk of diabetes complications
8. Potassium - detects concentrations that are too high(hyperkalemia) or too low(hypokalemia); hyperkalemia may indicate kidney disease
9. SGPT- ALT (Serum Glutamic-Pyruvic Transaminase - Alanine Aminotransferase) - give doctors important information about how well the liver is functioning and whether a disease, drug, or other problem is affecting it 
10. CYA C2 BY CMIA - monitors immunosuppresant/anti-rejection drug levels for management of organ transplant patients; levels below the range indicate lack of immunosuppresant drug dosage, higher than range numbers indicate drug over toxicity

Since the transplant, almost all my numbers have improved and most of them are within the normal range now except for BUN, Creatinine and CYA which needed tweaking by increasing or decreasing medication dosage. Weekly neph consultations are important to monitor symptoms of rejection or infection, both being the banes of transplant patients.

The neph is positive that the increase in creatinine is not caused by rejection or infection because I am asymptomatic of both. No fevers, no edema, no decrease in urine output, no cough/colds, no pain in the graft area.

My anti-rejection drug range is 1000 - 1300 nanograms/milliliter. The table shows my CYA levels and Creatinine the past month:

Date	Cyclosporin Dosage mg/day	CYA C2 nanograms/milliliter Range 1000-1300	Creatinine milliligrams/deciliter Range 0.5-1.3
13 Aug	250	366.5	2.1
20 Aug	300	721.2	2.3
03 Sept	350	994.1	1.9
18 Sept	350	2538.7	2-4
21 Sept	250	1018.6	2.5

            
Other possible causes of increased Creatinine are dehydration, diet excessive in protein and strenuous exercise. I take lots of water, my diet is well-balanced and my exercise consists only of toing and froing an 8-meter carport for 20 - 30 minutes on days when it's not raining. The task now is to identify what causes these irregular levels. 

Therefore I'm in for more visits to the lab and neph this coming week. I'll do repeat Creatinine and BUN tests plus a Doppler Ultrasound of the Renal Graft on Tuesday. To further isolate the results, I was ordered to a low-protein diet and to stop exercising for the meantime.

Meanwhile, just to rule-out rejection, I am placed on a pulsed infusion of oral Prednisone, an increase from 20 to 60mg/day. If the test result still indicate a rising Creatinine level, I may be again confined so intravenous pulsing can be administered. Of course I wouldn't want that. Hopefully, it doesn't happen. 

The journey continues.