Debbie,
Reads as though you have your bases covered. Here are a few articles hot off the press to share with your doctors. You have not only reduced kidney mass but a concern for hypertensive nephropathy which would be another insult to your kidney function. These articles talk about the known benefits of ACEI like your Lisinopril not only for BP but kidney protection and the use of sodium bicarbonate to treat tubular acidosis. Increasing your ACEI dose to treat BP requires being careful in monitoring serum potassium and increased creatinine to be sure do not have renal artery stenosis. If increasing ACEI causes a cough, can switch to ARB which is angiotensin receptor blocker. Angiotensin is a potent vasoconstrictor which increases pressure in blood vessels. Goal is to block this action and lower blood pressure including pressure within the kidney. Goal to to protect and preserve kidney function. Overall, your creatinines have held stable. One variable that cannot control is age--as we age, our kidney function declines so all the more reason to have an aggressive management plan so if things come up, know what to do. Great that you have shared your information so the reader can follow you over the years. I am due for a checkup next Monday so will let you know how goes. I do not have any family risk factors for cardiovascular disease. Appreciate that my physician is managing my lipid profile in setting of lone kidney. Need attention to the 'risks'--in order to prevent. Sounds like you are doing OK here. There is also a new treatment which ablates the renal artery (we have done this in clinical trials where I work but I do not know all the details) to treat high blood pressure. If you stay less than 120/80 you are doing great--lower is even better.
Phisitkul S, Khanna A, Simon J, Broglio K, Sheather S, Rajab MS, Wesson DE. Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury and better preserved GFR. Kidney International. 2010; 77: 617-623.
Sahni V, Rosa RM, Batlle D. Potential benefits of alkali therapy to prevent GFR loss: time for a palatable ‘solution’ for management of CKD. 2010. Kidney International. 2010; 78: 1065-1067.
Mahan A, Simoni J, Sheather JJ, Broglio KR, Rajab RH, Wesson DE. Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy. Kidney International. 2010; 78: 303-309.
De Brito-Ashurst I, Varagunam M, Raftery MJ, Yagoob MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009; 20:2075-2084.
I plan to talk with my physician about the role of sodium bicarbonate in the setting of reduced GFR even without ESRD. Why not take something that might protect my kidney. My creatinine has been stable at 0.8-1 since 1994. We'll see how goes. Other items might include low sodium and low protein diet. Makes the kidney not have to work so hard--and anything in lifestyle that can be changed like exercise, normal weight, no smoking, etc. It is OK to see a nephrologist if needed--they are experts in kidney function. Keep us posted--and I will do the same.
Donna