Essential Elements of a Nephrologist's Prescription: A Guide for Kidney Disease Patients

It's been quite some time since I last discussed the critical topic of kidney disease and the essential elements that should be included in a patient’s prescription. In my previous episode, I covered the very basics, providing a foundational understanding of what is necessary for managing kidney disease through proper medical guidance. However, recent experiences have compelled me to revisit and expand on this subject, ensuring that patients are fully educated about what they need to know.

In my practice, I have consulted with patients from all over Pakistan, both in person and through online consultations. These encounters have revealed some concerning trends in the prescriptions provided by some well-known doctors. Despite their reputations and the respect they command in the medical community, I have found significant gaps in the prescriptions that are crucial for effectively managing kidney disease. This realization motivated me to bring this issue back into focus and educate patients on what to look for in their nephrologist’s prescription.

The Prescription Reflects the Doctor's Understanding

The prescription given by any doctor is not just a piece of paper; it is a reflection of the doctor’s thought process, understanding of the disease, and overall comprehension of the patient’s condition. We cannot take a doctor’s prescription lightly because it forms the basis of the patient’s treatment plan. The effectiveness of the treatment, whether it leads to improvement or deterioration in the patient’s health, depends largely on what is prescribed.

As my practice has grown, I have had the opportunity to consult with patients from various parts of Pakistan, especially those from major cities who seek online consultations. This has allowed me to review prescriptions from their previous nephrologists or other healthcare providers. Before moving forward with any treatment, I ensure that the patient informs me of what their previous doctor prescribed and whether their understanding of the disease aligns with what was advised. Only then do I proceed, as it is essential to have a clear picture of what has been done so far.

This approach has given me insight into the prescriptions of many renowned doctors, including those who frequently appear on television to discuss healthcare. Unfortunately, I often find that their prescriptions do not reflect the level of intellectual understanding or wisdom they profess in their public appearances. Moreover, many patients report dissatisfaction with these doctors, which is concerning.

The Reality of Patient-Doctor Relationships and Perceptions

It's important to clarify that the relationship between a doctor and a patient is based on reality, but perception also plays a significant role. I agree that it is not possible to satisfy every patient, especially in cultures like Pakistan and India, where patients often seek medical help only at an advanced stage of their illness. However, there is usually evidence indicating how well the interaction between the doctor and the patient went.

For instance, if a patient tells me that their doctor didn’t explain anything to them, and then I review the prescription and find it detailed and comprehensive—listing things like the disease stage, blood pressure, and dietary instructions—I will advocate on behalf of the doctor. I might tell the patient, "Look, the doctor has clearly noted your condition, provided a diet chart, and recorded your blood pressure accurately. Perhaps you didn’t connect well with the doctor or chose not to follow the instructions."

When I have all this information, I can discuss the situation with the patient logically and healthily. I try to explain that if they continue to ignore their health or fail to understand their disease, even spending more time with me will not benefit them. This is why I make it a point to study each patient’s previous interactions with their doctors. If there was a deficiency on the doctor’s part, I try to address it, but if the patient was disinterested in their own health, I take a different approach in our discussions.

Essential Elements of a Nephrologist's Prescription

Now, let's move on to the core of this discussion: the essential elements that should be present in every nephrologist's prescription.

1. Vital Information: Patient Identification and Vital Signs

The prescription must begin with the patient’s complete name, age, and contact number. Following this, the most important section is the patient's vital signs. You must ensure that your doctor has recorded at least the following on your prescription:

• Blood Pressure: Your blood pressure is a critical indicator of your kidney health and overall cardiovascular condition.
• Heart Rate: Monitoring your heart rate provides insight into your cardiovascular health.
• Breathing Rate: Your breathing rate can indicate issues related to fluid overload or other complications.
• Weight: Tracking your weight is crucial for managing kidney disease, as it helps monitor fluid retention and other related issues.

These parameters allow any doctor to compare your home blood pressure readings with those taken during your next visit. It also gives a clear picture of your condition at a specific time. For example, if a patient visits me in 2024, and their last visit to a doctor was in 2020, the prescription will tell me what their condition was back then—whether their blood pressure was 180/90 or 120/70, or whether their weight was 105 kg or 75 kg. This information helps me understand the patient’s progress and future prognosis.

2. The Stage of Kidney Disease

The next critical piece of information that must be included in the prescription is the stage of your kidney disease. Understanding the stage of your kidney disease is crucial because it influences your entire treatment plan, lifestyle changes, and future outlook. Your nephrologist must record the stage of your kidney disease on the prescription. Without this information, you should not leave the doctor’s office.

3. The Cause of Kidney Disease

Another essential aspect of the prescription is identifying the cause of your kidney disease. I have discussed the various causes of kidney disease in detail in different videos. Kidney disease does not occur in isolation; there is always an underlying cause. Among every 100 patients with kidney disease, approximately 40-45% have diabetes as the root cause, 30-35% have hypertension, and 10-15% have glomerular diseases caused by autoimmune destruction within the kidneys. Other causes include drug side effects, polycystic kidney disease, and numerous other factors.

In short, what you need to understand is that kidney disease is a symptom of an underlying problem. Knowing this underlying cause is crucial because the treatment of kidney disease is based on it.

4. Protein in Urine

A segment that is often overlooked but is critical in the prescription is the presence of protein in urine. Since returning to Pakistan, I have been deeply concerned by the lack of attention given to this important indicator by both patients and doctors. Protein in urine is a significant marker of kidney disease, and its presence should not be ignored.

You must ask your doctor how much protein is present in your urine, what the normal levels are, and what the abnormal levels indicate. Understanding the severity of proteinuria and how it will be managed with treatment is vital because the longevity of your kidneys depends on this number.

5. Treatment Plan: Medications

The next section of the prescription is dedicated to the treatment plan, particularly the medications. Medications are always prescribed with a purpose. While symptomatic relief is part of their role, the primary goal of medications is to cure, halt, slow down, or manage the disease.

You must review all the medications listed in your nephrologist’s prescription and ask questions about each one. What is this medication for? What are its benefits? What are its potential side effects? Not understanding these aspects is why many patients remain confused and may even stop taking important medications like ACE inhibitors, ARBs, or SGLT2 inhibitors. They might stop taking these because someone outside the doctor’s office tells them, “This is a diabetes medication, not for kidneys,” not realizing the significance of these medications for kidney disease management.

If your nephrologist has thoroughly explained the purpose and benefits of these medications, you would be confident in your treatment. You could then explain to anyone questioning your prescription that these medications have been proven to be beneficial in both diabetic and non-diabetic kidney disease patients, as well as for managing blood pressure and heart issues.

6. Targets: Vital Signs and Lab Results

The final section of the prescription should outline your treatment targets, including both vital signs and laboratory results. Your nephrologist must inform you of your targets—whether for reversing, controlling, or managing diabetes, and what your hemoglobin A1c levels should be, among other targets.