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High Blood Pressure
We are not born with high blood pressure (HBP), but develop it during our lifetime. It typically begins during a person’s 40s, 50s, or 60s.

By age 60, 80-90% of Americans will have abnormal blood pressure. This is actually an adaptation to aging, but in the long term, HBP is not beneficial for your health if it is not treated. High blood pressure results in increased risk of stroke, kidney disease, and heart disease.

Both numbers are important, but for people age 55 and older, the top number continues to rise while the bottom number begins to drop as a process of aging. This is called isolated systolic hypertension (ISH).

In this population, following the systolic number is more important. Medical literature shows that the systolic number being high is directly related to organ damage in the form of stroke, kidney disease, heart disease, and eye damage. Treating this early before damage occurs is the key to preventing these complications.

High blood pressure is a silent killer. The majority of patients do not suffer from symptoms even when blood pressure reaches a severe level of systolic above 185-200 mmHg. So typically these medications do not make you feel better. In fact, most people feel no difference except that their blood pressure is controlled.

If taking medications results in fatigue, this typically means (a) that the medication is very effective and drops your blood pressure too low, too soon, or (b) you just don’t tolerate the medication. Your doctor should be aware of your fatigue so he or she can adjust your medications.

Kidney Disease
This is most likely due to abnormal kidney parameters that your PCP has checked as part of a complete evaluation. You may have an abnormal serum creatinine, abnormal eGFR, or abnormal protein levels in the urine.

Your PCP is correct since kidney disease is silent until the very late stages. You do need to see a nephrologist. The earlier this problem is addressed, the more that can be done to keep you at your healthiest.

No, your problem has to do with your bladder’s capacity to hold or release properly. Problems with this may be due to poor pelvic muscles, nerve damage to bladder nerves, diabetes, giving birth, or prostate enlargement or surgery.

This problem is not due to your kidneys. It requires evaluation by a urologist, who is the surgical counterpart to a nephrologist and is involved with the mechanical (plumbing) issues of the urinary tract. By contrast, a nephrologist takes care of medical conditions related to the kidneys and their chemical functions.

Kidneys have many functions. Normal kidneys (unless you have only one) work to filter and purify your blood, which carries your body’s waste products mainly in the form of acid (excreted as ammonia). They maintain healthy levels of electrolytes and minerals by either excreting what is in excess or retaining what is deficient.

The kidneys also determine your total body water needs and adjust your sodium levels depending on your diet. Because of these properties, the kidneys are the control tower of your blood pressure.

In addition, kidneys activate vitamin D to its effective form and give feedback to parathyroid glands, which, if not monitored, can lead to a form of kidney osteoporosis called metabolic mineral bone disease or chronic kidney disease (renal osteodystrophy).

Lastly, the kidneys produce erythropoietin, a hormone that promotes the formation of red blood cells by the bone marrow. Maintaining a normal level of red blood cells is important in order to avoid anemia.

Controlling your blood pressure consistently to stay at target is the number one proven action you can take to keep your kidneys from getting worse.

In addition, certain patients with proteinuria will benefit from the use of ACE inhibitors, ARBs, or spironolactone, a potassium-sparing diuretic. This is a decision that must be made by your doctor since not all medications are suited for everyone.

Make every doctor you see aware that you are a kidney patient. Your nephrologist should also be an advocate for this.

Avoid over-the-counter (OTCs) medications as per your doctor’s recommendations, specifically the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen sodium (Aleve).

In addition, the combination of Tylenol (acetaminophen) with aspirin can cause the kidneys to form a toxic by-product if taken regularly.

No supplements have been proven to keep your kidneys healthy. These agents are not regulated by the FDA, which means they are not regulated for safety, efficacy (to actually do what it promises), and dosing consistency – even from bottle to bottle.

Herbal supplements comprise a multimillion dollar business that is not liable for long-term harm to your health. To date, there have been no significant published randomized controlled clinical trials that testify to the health benefit of herbal supplements. They all contain a label in very fine print on the side of each product that states “this is not intended to diagnose, treat, or cure any medical condition.”

The following have been listed by the National Kidney Foundation as possibly harmful for people with kidney disease: ginseng, ginger, noni juice, alfalfa, aloe, rhubarb, and licorice to name a few. For more information, visit the National Kidney Foundation’s website.

Yes, you are describing restless leg syndrome (RLS), which is a neurological disorder. Its cause is unknown, but it is associated with diabetes, peripheral neuropathy, and kidney disease. There is no known cure for RLS, but treating the associated illness helps control it. RLS occurs during prolonged rest, or at night. Ask your doctor about therapy available to help with symptoms.
No. Early stages of kidney disease are treatable and can be managed through medication and lifestyle changes. If underlying conditions like hypertension and diabetes are kept under control, kidney disease may never progress to the stage where transplant and/or dialysis are necessary.
Office information
You may call to make an appointment during our office hours. We are open Monday through Thursday from 9 am to 5 pm and Friday from 9 am to noon. In addition, both new and established patients can also make appointment requests through our patient portal.

We do not allow walk-ins since all appointments are filled. We do accommodate our patients promptly if a problem arises, but this must be scheduled by phone to meet your needs.

  • Insurance card
  • Picture ID (driver’s license or passport)
  • Referral or authorization forms if required by your insurance plan
  • New patient registration form
  • Health history form
  • All prescription medications you take (actual, current prescription bottle is best)
  • Your home blood pressure monitor (we check it once a year to make sure it is accurate)
  • Payment for insurance co-pay

Some insurance plans require you to obtain a referral from your primary care physician (PCP). Insurance requirements may differ from one plan to the next. Please check to see what your plan requires, including the need to pick up the referral from your PCP. Each patient has this responsibility.
Being punctual is a priority for our office. We only schedule one patient at a time – no one else has your scheduled appointment. While emergencies may occur that require the immediate attention of a doctor, we keep them to a minimum. If there is any delay, our staff will keep you posted. We appreciate your cooperation and understanding.
Since there are other patients in the schedule, being 10-15 minutes late for your appointment may result in either having to wait until the next available time or moving your appointment to another day. If you call us in advance, we will have a better chance to work you in. Thank you for your understanding, as we do not want to pass any delays onto anyone else’s appointed visit.
We understand that sometimes your schedule changes. Because of the time devoted to each patient, appointments fill up quickly and there is a waiting list for many patients who need to be seen.

If you would kindly notify us during office hours with at least 24 hours’ notice, it should not be a problem. The sooner you can notify us, the sooner we will be able to reschedule your appointment.

Due to our limited appointments, any no-shows or cancellations that are not called in during office hours at least 24 hours in advance will result in a $25 charge.

Our office works to promptly handle any problems related to your care that you specifically receive from us. All phone calls and requests are handled by our professional staff, and they will give you an estimated time frame to expect a response.

Depending on the medical urgency, your call will be returned within the day to 48 hours by our staff. Multiple calls regarding the same problem are not necessary. All medical questions are reviewed and answered by your doctor.

Our doctors only refill prescriptions for the medications they prescribe, and only during regular office hours. You also have the option to request refills at least one week in advance online.

Please bring all of your medicine bottles with you to your appointment for proper care. We recommend submitting refill requests 7-10 days prior to running out, since emergency refills are not in our office policy.

If you have any kind of reaction or problem with any medication you receive from your kidney doctor, please call the office and report it. Your doctor will address it and any make necessary changes, including changes to the dose or type of medication. A visit is rarely necessary to resolve these issues.
Our doctors review all bottles, pills, and how prescriptions are printed to best advise you on medication interactions and also to be able to recommend the appropriate dose for patients who need special dosing.

Also, many pills are not meant to be cut and become non-effective when cut. Just remember, all medicines are filtered by your kidneys. We have seen many mistakes in medication lists. It’s only human. Thank you for your cooperation in helping us to provide you with the best care.

We do have an after-hours on-call physician for medical emergencies related to kidneys and high blood pressure. For other matters, please make sure to contact your PCP, or if necessary call 911. To better serve your non-urgent matters, such as appointment problems and insurance issues, we recommend calling during office hours.