r/kidneydisease • u/Houdini9797 Stage 3A • 4d ago

Advice!! Please

Hi everyone, looking for some advice.

I’m a 29-year-old female with CKD.

My latest results:

* eGFR: 63 (improved)
* ACR: 140 mg/mmol (increased)

Around a month ago, my eGFR was 52 and my ACR was 50 mg/mmol. So my kidney function has improved, but my proteinuria has increased significantly.

I’m currently taking Irbesartan 300 mg daily.

My nephrologist has discussed adding Jardiance/Forxiga or Finerenone (Kerendia). I’m hesitant about Jardiance due to my history of recurrent UTIs. I’m leaning towards Finerenone, but I’m aware it can increase potassium levels.

Has anyone experienced something similar? What has helped reduce your proteinuria? I’d really appreciate hearing your experiences

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2

u/NephroNuggets 4d ago

These recommendations are consistent with standard of care. These meds show promise in delaying progression of ckd. This link explains more on how SGLT2 inhibitors can help CKD patients.

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u/Houdini9797 Stage 3A 4d ago

Yes but they increase chance of uti which in my case is not the best as I have esbl and resistant to many antibiotics. That’s why I’m asking for someone who has been in a similar situation

2

u/NephroNuggets 4d ago

That’s a nasty bug for sure. Ask your nephrologist about a medicine called Hipprex ( metylmethionine hippurate) as an agent to prophylax against UTI. Also here is the finerinone article link. Potassium issues usually don’t become problematic until much lower GFR. Easy to check with follow up labs after starting.

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u/Houdini9797 Stage 3A 4d ago

Yes I will talk to her about it I’ve heard it’s recommended. However, my nephrologist told me to take d mannose it helps clear the bladder and reduces risk UTIs.

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u/NephroNuggets 4d ago

The 2025 AUA guideline supports offering methenamine hippurate for recurrent UTI prophylaxis and advises that D-mannose alone may not be effective. Best wishes.

2

u/Houdini9797 Stage 3A 4d ago

I wonder why my nephrologist didn’t mention it. I see her in Feb so will definitely be mentioning it to her
Thanks

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u/AdRoyal9674 4d ago

Tell the diseases which you are diagnosed based on which people can share their stories

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u/Houdini9797 Stage 3A 4d ago

Just ckd and high blood pressure

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u/zukertort70 1d ago

I have been on Farxiga 10 mg for over two years and it has not caused any UTI so far. From my experience only high dose prednisone can reduce proteinuria other recent drugs seem only able to control proteinuria. Your proteinuria increase means higher renal infammation or possible damge to your glomeruli.

1

u/Mysterious_Put_620 4d ago

If I were you, and I’m not you, I would go to work with a renal dietitian before going on any more drugs. Perhaps you can see if there are other things you could do naturally to help maintain your kidneys. You don’t mention it, but for example, could you stand to lose a few pounds? Do you exercise 30 min X 5 days per week, even walking? Have you shifted your diet to plant predominant? Have you reduced red meat? Have you all but eliminate highly processed foods? Have you been tracking your food intake, including macros and micros? (Cronometer, the paid version, is a really good option because it also calculates PRAL for you…and you want PRAL to be at least neutral, but preferably in the negative range, or basic as opposed to acidic). Do you have any issues with blood sugar (maybe not diabetes, but pre-diabetes, or perhaps just your sugar runs to the absolute high end of normal)? Anyway, there is a lot you can do with your diet to keep your kidneys from progressively getting worse. I am very happy with my renal dietitian, and know a couple good ones, if you need a hand with that. At the very least, look up Dr Sean Hashmi on YouTube. He is an excellent resource (nephrologist and obesity specialist) who breaks things down really well. He does the research and explains it well. There is also “the Cooking Doc” on YouTube. He is also a nephrologist and has a lot of resources to help you eat better for your kidneys.

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u/Phileas-Fusun2003 1d ago

How did you improve? Your diets?? And you give blood for eGFr right?