My dad has one kidney. Three times in the last year he has experienced severe leg pain and vomiting leading to hospitalization. They tell us it is low sodium but how does he prevent this?

There are many causes of a low blood sodium (hyponatremia). There are many drugs that cause hyponatremia including some diuretics, thyroid disease, heart disease, dehydration syndromes with water replacement, liver disease, kidney disease, lung disease and adrenal disease. Hence, in order to know how to correct the problem, it is necessary for the physicians caring for your father to make a specific diagnosis and then start specific treatment for that condition.  

The criteria for determining CKD is very confusing to me. As you know, the Merck Manual lists 5 stages of CKD. From reading some of your past posts it appears that you consider eGFR 60 or above to be normal. I have read that one of the following must be present for > or = three months to be CKD: GFR 29, or other markers of kidney damage. According to this criteria, it appears to me that stages 1 & 2 of CKD as defined in the Merck Manuel are completely ignored. Please explain.The other question I have is that the National Kidney Foundation website states that 37, 000, 000 adults have CKD in the US. There is no explanation as to what that number includes. That seems to be a lot of people to be in stages 3,4, & 5 so does that number include stages 1 & 2?

There are 5 Stages of chronic kidney disease (CKD) that have been proposed by the National Kidney Foundation (NKF). The estimating equation that we use to calculate the estimated glomerular filtration rate (eGFR) is most accurate and consistent when the eGFR is 60 milliliters per minute per 1.73 meters squared or less. Hence, if we are going to use the eGFR only to make a diagnosis of CKD, it is best when the eGFR is less than or equal to 60.

Stage 1 CKD is indicated when there is abnormal urine (such as blood, protein or infection) that is present for at least three months, there is an abnormal ultrasound such as polycystic kidney disease or an abnormal kidney biopsy AND the eGFR is normal at between 90 and 120. Stage 2 CKD is indicated by urine or ultrasound abnormalities or a kidney biopsy that is abnormal for at least three months AND the eGFR is between 60 and 89. Stage 3 CKD is diagnosed if the eGFR is between 30 and 59 AND is present for at least three months. No urinary or other findings are required but are confirmatory for CKD. Stage 4 CKD is an eGFR between 15 and 29 for at least three months. Stage 5 CKD is an eGFGR less than 15 and present for at least three months.  You can learn more about CKD Staging at our web site at: https://www.kidney.org/professionals/explore-your-knowledge/how-to-classify-ckd

The estimate for CKD recently posted on the NKF web site is from the Centers for Disease Control and can be found at:  https://www.cdc.gov/kidneydisease/pdf/2019_National-Chronic-Kidney-Disease-Fact-Sheet.pdf

A majority of the people with CKD are in Stage 1 or 2 and unaware of their kidney disease.

Hi there. I got some test results in today and the note said to come here. GFR MDRD Af Amer 99 See Note See Note. GFR is estimated using Creatinine, age, gender and race. Patient’s values should be interpreted as a trend. Below 90 ml/min/1.73m2, the patient may have renal disease.

The result mentioned is that your estimated glomerular filtration rate (eGFR) is 99 milliliters per minute per 1.73 meters squared if you are African American and 81 milliliters per minute per 1.73 meters squared if you are non-African American.

In order to diagnose chronic kidney disease (CKD), your eGFR must be in a stable range for at least three months and you must also have testing of the urine for blood, protein and infection.  Hence, you will need to review the results with your physician in order to determine if you need further testing.

For more information about CKD, you can also visit our web site at:  https://www.kidney.org/professionals/explore-your-knowledge/what-is-the-criteria-for-ckd

My Daughter is 47, has type 1 diabetes and kidney disease. Her last blood work in Feb/2024 has Urine Protein/Creatinine Ratio of 6.308 – BNP is 488.8 – Microalbumin Urine of 795.5 -Microalbumin/Creatinine Ratio of 5,625 – Protein Urine Random of 246. Glucose – BUN 47 – Creatinine 1.87, Free Kappa Light Chains Ur 66.85 – Lambda Light chain Free Urine 27.27 – Free Kappa / Lambda 2.45. She can’t see Kidney Doc till July/August. Should I be worried?

The information that you present suggests that your daughter has diabetic kidney disease. The treatment of diabetic kidney disease is to use ACE-inhibitors or ARB agents to treat protein in the urine and control high blood pressure. Her diabetes should be carefully controlled with a HgbA1c between 6.0 – 7.0%. The results of the Kappa and Lambda light chains depend on the local laboratory normals. Your daughter should also follow a low salt diabetic diet.  

If your daughter is doing all these things, then her primary care physician (PCP) is doing a good job at managing her disease and waiting to see the nephrologist should be fine as further treatment depends on a complete history and physical examination.  

Have stage 3 CKD, am on Allopurinol, Losartan, Amlodpine. Going to try 0.4mg Tamsulosin. Any problem adding this to my regimen? Thanks.

Tamsulosin is a peripheral alpha blocker used to facilitate emptying of the bladder in patients with benign prostatic hypertrophy. If this was prescribed by your physician, this is a common medication used in patients with chronic kidney disease (CKD). These medication should be safe together but should be monitored by your physician. There can be unforeseen side effects that need to be monitored. You should monitor your blood pressure at home.  

Recently my 4 year old daughter was admitted in hospital with fever and vomiting. Our doctor advised for Ultrasound. During the processes, the ultrasound report came out as mentioned below says:1. Left Kidney not seen in the native Fossa-Possible Agencies/Ectopic”2. The focal Hypoechoic bowel loop in the left iliac fossa suggest to rule out intussusception.Therefore, I would like to seek your advice on this matter.

I am an adult nephrologist and do not see children. The findings on ultrasound suggest that your daughter may have congenital abnormalities in her abdomen of her kidney and bowel. These should be addressed to a surgeon for examination. A pediatric surgeon or a pediatric urologist should be consulted about the abdominal findings.  

What diet should I follow if I have stage 3 kidney disease, no diabetes, blood pressure 128, non smoker, not overweight?

I am a strong proponent of the DASH diet. You should limit your sodium intake to less than 2300 milligrams per day. You can review the DASH diet on our website at:  https://www.kidney.org/atoz/content/Dash_Diet

I am almost 63, have always been thin, exercise regularly and eat pretty clean. My only current diagnosis is Osteoporosis, but my mother died of heart disease and kidney failure, and my father also had heart issues. The only Rx I will begin taking now is Prolia. My CRP on bloodwork has been hovering around the low 60’s and upper 50’s for as long as I can remember seeing it on lab results. My health professionals never seem to pay much attention to the low number. I want to gain muscle, so I would like to eat more protein (pretty sure I don’t get enough.) I have tried to increase my water intake, although that has been an area I have not done well with for most of my life. BP has been slowly creeping up over the last few years (readings average 128/78-ish) The question is: is it safe for me to aim for approx. 75g of protein daily? Will hydrating more help to offset the protein? Or am I destined to be underweight (currently 5’7” and 112 lbs) in order to protect my kidneys?Thank you so much, in advance. It will ease my mind greatly to have an answer.

I am not sure about your question. A “CRP” is a C-reactive protein. I don’t see any information about your kidney function, unless the 50 and 60 actually represent estimated glomerular filtration rate (eGFR).  

I am a strong proponent of the DASH diet with limited sodium intake.  You should take in less than 2300 milligrams of sodium per day. Protein intake should be in the range of 0.8 to 1.5 grams per kilogram body weight per day. Hence, at your body weight of 112 pounds or 51 kg, your protein intake could be between 41 to 76 grams per day.

You can review the DASH diet on our website at:   https://www.kidney.org/atoz/content/Dash_Diet

I have one kidney and a GFR of 53. I had robotic hernia repair surgery on Monday. The surgery ended at about 9:30am, but by 2:00pm I still could not urinate and so was catheterized (not Foley). I went home and at about 3:30pm took one Flomax. Over the next 24 hours I urinated 6.2 liters, having consumed 6.0 liters during that period. Is that kind of quick turnaround in urination normal after surgery? Is it healthy to urinate that much with a single kidney? Thank you in advance for your response. Kind regards.

I am a nephrologist and have no surgical expertise.  Urine output is related to fluid intake. Hence, the fluid you drank after surgery and the intravenous fluid that you received during your surgery would have to be eliminated. Whether you have two kidneys or one kidney, elimination of excess fluid is the responsibility of the kidney. I would not be concerned about the amount of urine that you are producing. I would rather have you seek consultation with the surgeon, who performed your surgery, with any concerns that you may have.  

I am a female aged 49.5 with an eGFR that went from 108 (July 2022) to 83 (May 2023) and 86 (4/5/2024). Based on the optimal range it would appear I might be in stage 2 CKD. Why do some labs use the reference range of >59 for all age patients while the Kidney.org website uses a cut-off of 90? (I am a veterinarian that does not use eGFR on her patients but still love to trend values). Should I be worried? Kidneys look normal size on AUS just a small suspected 1.2cm angiomyelolipoma on the left and an equally small cyst on the right. Heading to Urologist at Mayo for work-up but so very curious!

The estimating equations that we use to calculate the estimated glomerular filtration rate (eGFR) are not consistently reproducable when the eGFR is greater than 60 milliliters per minute per 1.73 meters squared. This is also influenced by the accuracy and consistentcy of the laboratory measurement of serum creatinine within the normal range. Hence, we use the normal for an eGFR to be greater than 60.  

However, there are more accurate ways of measuring the GFR such as iothalamate clearance, inulin clearance and in some cases using the Cystatin C calculation.  

You should also have urine testing for blood, protein and infection in order to complete the screening tests for chronic kidney disease (CKD).  Your eGFR by itself does not define CKD unless it is less than 60.    

Hi Doctor, I am a 68 yr old male. I am 5’7″ 145 lbs. I exercise with weights at least 3 times per week and would do more except for severe back pain. Stopped smoking 24 years ago. I have a touch of hyperglycemia. In other words, it is not a chronic problem by any means. Maybe 4 or 5 times per year.I am concerned about my eGFR value of 85, which was taken today. It is down from 91 a year ago, but 4 points of that are just from last month. I know I have been using more salt than I used to but do not know if that could be the cause. What supplements or life changes would you advise for me? Thanks very much for any help.

This is normal laboratory variation.  The serum creatinine will vary plus or minus 0.2 milligrams per deciliter.  This will lead to variation in the estimated glomerular filtration rate (eGFR).  The normal for the eGFR is greater than or equal to 60 milliliters per minute per 1.73 meters squared.  Hence, your eGFR is normal.  You should also have a urine test for blood, protein, and infection in order to complete screening for chronic kidney disease (CKD).  

I suggest you review your diet with your primary care physician (PCP).  I am a strong advocate for the DASH diet.  You can review the DASH diet at: https://www.kidney.org/atoz/content/Dash_Diet

You should also limit your sodium intake to less than 2300 milligrams per day.  

Thank you for helping me out. I have had five kidney cancer procedures that have caused my eGFR are to decrease. It ranges from 54 to 74. I am also on Pebbles and Levantinib for kidney cancer. My nephrologist and I are thinking about me going on Jardiance to protect my kidneys. We are both searching for other opinions. Thank you.

Jardiance (Dapagliflozin) is a Sodium GLucose co-Transporter 2 (SGLT-2) inhibitor. It is used in patients with chronic kidney disease (CKD) to slow progression of CKD, but is most effective when used with patients who spill protein (albumin) in their urine.  I have never used Jardiance in the situation that you describe and I am unaware of any research studies looking at this issue.  

You should discuss this with your oncologist to make sure that Jardiance does not interfere with the chemotherapy that you are receiving.   

Hello, I have a bun level of 28. It has raised from 21 two years ago. How concerned should I be? I am seeing my GP on this Friday. I can’t during the day hold my urine for more than two hours. Thanks.

The blood urea nitrogen (BUN) is a test that is often difficult to interpret.  If the rest of your kidney tests are normal, the BUN test is of no consequence. You should also have a urine test for blood, protein and infection to complete screening for chronic kidney disease (CKD).