Dear Dr. Roach: I鈥檓 an 87-year-old female who still works part time and still drives and gets around without any help. I鈥檓 in fairly good health, except that my creatinine is high.
I believe that normal creatinine is about .07-1.00. Currently, mine is 1.31, and it seems to go higher every time I have it checked, which is every three months. What is causing that, and what can I do to bring it down or keep it from rising any higher? I was advised by my nephrologist that if it reaches a certain number, I will need dialysis.
Anon.
Creatinine is a muscle-breakdown product that is a good marker for kidney function. The higher it is, the worse the kidney function. Kidney function reliably decreases as we age, but at very different rates for different people. Also, because muscle mass tends to decrease with age, a high creatinine means worse kidney function in an older person than in a younger one.
Your nephrologist can make a graph of creatinine (actually, one over creatinine) against time, which allows him to make a guess about how long it will take your creatinine to get into the range of needing dialysis (that鈥檚 about 10, but it can vary dramatically, since the decision to start dialysis isn't made on creatinine but on potassium and acid levels or by symptoms of kidney failure). Since you are 87 and your creatinine is only 1.3, I鈥檇 be willing to bet that it will be a long time.
The most important thing you can do to protect your kidneys is avoid drugs that are toxic to them, especially high doses of anti-inflammatories such as ibuprofen or naproxen, but also too much acetaminophen (Tylenol). Drink a good amount but not an excess of water. If you are taking any medications, your kidney doctor will have checked your doses. An 87-year-old woman with reduced kidney function needs different dosing from a 25-year-old man.
听
Dear Dr. Roach: What is your opinion on whether vaccines can cause autism? I have read advice to look at both pro-vaccine and anti-vaccine information.
I.J.
This question has been the subject of many different studies since a paper in 1998 suggested a link between the measles, mumps and rubella vaccine and autism. The study has since been retracted, and the lead author subsequently lost his ability to practise medicine after a medical council found him guilty of misconduct.
The pro-vaccine side has the weight of the scientific community and evidence, while the anti-vaccine side has anecdotal reports, unsubstantiated claims and conspiracy theories. Unfortunately, the anecdotal reports are scary, and no parent wants to take an unnecessary chance. But we shouldn鈥檛 make important decisions about our children's health based on bad evidence.
The two sides aren鈥檛 equal. Every medical society has looked at the good effects and the bad ones of the MMR (and other) vaccines and has recommended them. The benefits of protecting against life-threatening illness far outweigh the small (but not zero) risks of the vaccines. I strongly endorse staying with the recommended vaccine schedule for the health of both your child and your community.
