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.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney Biopsy, Kidney-Related Health Questions, Polycystic Kidney Disease | Comments Off on 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?

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

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Urinary Tract Infection/Pyelonephritis | Comments Off on 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.

My Mom is 89 yrs old. She is on dialysis. She was given Cefdinir 300mg to be taken for 14 days once every 48 hrs for suspected UTI and kidney stone. She was also told to take an over-the-counter probiotic with it. She has taken 10 doses of the Cefdinir so far and has developed diarrhea, gas, and feeling weak. Is this dose too strong for her? Should she continue the medication? Is there another antibiotic that would work better? Thank you.

Your mother may be developing a complication of her antibiotic treatment. I recommend that you notify her physician right away and ask for a review of her situation and advice regarding her treatment. I am unable to offer medical advice without performing a complete history and physical examination.  

Posted in Ask the Doctor, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function | Comments Off on My Mom is 89 yrs old. She is on dialysis. She was given Cefdinir 300mg to be taken for 14 days once every 48 hrs for suspected UTI and kidney stone. She was also told to take an over-the-counter probiotic with it. She has taken 10 doses of the Cefdinir so far and has developed diarrhea, gas, and feeling weak. Is this dose too strong for her? Should she continue the medication? Is there another antibiotic that would work better? Thank you.

I have stage 2 CKD, hypertension, high cholesterol, eczema, and sleep apnea. I am on MAO Inhibitor for depression. Just finished 20 radiation treatments for DCIS and LCIS. Will Letrozole conflict with any of the above health issues? How much protein per day should I get if I’m 5′ 4″, 145 lb?

Letrozole is an anti-androgen and anti-estrogen drug often used to treat breast cancer. The dose does not change for patients with minor kidney disease.  

I do not recommend protein restriction for patients with chronic kidney disease (CKD). I recommend that you avoid high protein diets. I would consider protein intake of greater than 1.5 grams of protein per kilogram of body weight per day, to be a high protein diet. Your weight of 145 pounds is about 66 kilograms, so you should not take more than 100 grams of protein per day.

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function | Comments Off on I have stage 2 CKD, hypertension, high cholesterol, eczema, and sleep apnea. I am on MAO Inhibitor for depression. Just finished 20 radiation treatments for DCIS and LCIS. Will Letrozole conflict with any of the above health issues? How much protein per day should I get if I’m 5′ 4″, 145 lb?

What is the GFR that a pediatric patient must reach in order for insurance to allow the transplant process to move from inactive to active?

That is a decision for your insurance company. I am an adult nephrologist and Medicare requires an estimated glomerular filtration rate (eGFR) of less than 20 milliliters per minute per 1.73 meters squared for patients to be placed on the kidney transplant list. I am not sure I am aware of such a requirement for children. In most situations, your insurance company must make a coverage decision regarding eligibility for kidney transplantation. In some pediatric transplant centers, the child must reach a certain weight before they will be considered for kidney transplantation. Hence, I suggest that you review this with your insurance provider and the transplant unit that is considering the child.

Posted in Ask the Doctor, GFR, Insurance & Medicare Coverage, Kidney-Related Health Questions, Nephrologist, Transplantation | Comments Off on What is the GFR that a pediatric patient must reach in order for insurance to allow the transplant process to move from inactive to active?

I am a 52 year old female. I have been getting up to use the bathroom multiple times per night and it’s attributed to menopause. My latest blood work in January has EGFR 58, BUN Creat Ratio 13, Creatinine 1.00. The EGFR is flagged for abnormal low. The doctor says my kidney function is fine and the low value is due to fasting bloodwork. I had/have migraines for years and admittedly used way too much Excedrin without a useful alternative until CGRPs. I also used PPI for GERD and ulcers. I recently switched to Pepcid due to memory loss. Is the EGFR something I need to pursue? The fasting answer doesn’t sit right when 5 years ago my value was much higher. I don’t have my other results but he does blood work every 6 months. Am I worrying for no reason?

I suggest that you have repeat testing to see if it is persistently low. It is occasionally possible that laboratory variability could be showing a very mildly low result (the normal for an estimated glomerular filtration rate is greater than 60 milliliters per minute per 1.73 meters squared). Repeat testing may show it back in the normal range. I also recommend urine testing for blood, protein and infection. This will complete the screening testing for kidney disease. Once these tests have been repeated, you can then discuss your concerns with your physician.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions | Comments Off on I am a 52 year old female. I have been getting up to use the bathroom multiple times per night and it’s attributed to menopause. My latest blood work in January has EGFR 58, BUN Creat Ratio 13, Creatinine 1.00. The EGFR is flagged for abnormal low. The doctor says my kidney function is fine and the low value is due to fasting bloodwork. I had/have migraines for years and admittedly used way too much Excedrin without a useful alternative until CGRPs. I also used PPI for GERD and ulcers. I recently switched to Pepcid due to memory loss. Is the EGFR something I need to pursue? The fasting answer doesn’t sit right when 5 years ago my value was much higher. I don’t have my other results but he does blood work every 6 months. Am I worrying for no reason?

I just got some results. My eGFR was 79. I have protein in the urine of 0.30. I have been supplementing with whey protein of about 50g daily, not exercising. Just thought it would be good to take. I am being monitored for lupus. My thinking is it could be lupus. I have other indicators that say I could have lupus. My water intake is not the best. I’ve stopped taking the whey and going to hydrate more and see my rheumatologist about taking Plaquenil. How much can the extra protein be the problem? Thank you.

The normal for a urine protein test is less than 0.2 milligrams of protein per milligram of creatinine. Hence, your test is just very slightly elevated. Your estimated glomerular filtration rate (eGFR) is within the normal range. The extra whey or milk protein is likely not a factor in your kidney disease and I am not sure I can diagnose chronic kidney disease (CKD) based on the information that you present. Your urine protein should be repeated to see if it is consistently elevated over time.  

I am not an advocate for a high protein diet, so I approve of your decision to stop the extra protein and I would recommend a healthy diet, such as the DASH diet. You can review the DASH diet at: https://www.kidney.org/atoz/content/Dash_Diet

If your urine test remains persistently abnormal, then further evaluation may be necessary.,  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diet/Nutrition, GFR, Kidney-Related Health Questions | Comments Off on I just got some results. My eGFR was 79. I have protein in the urine of 0.30. I have been supplementing with whey protein of about 50g daily, not exercising. Just thought it would be good to take. I am being monitored for lupus. My thinking is it could be lupus. I have other indicators that say I could have lupus. My water intake is not the best. I’ve stopped taking the whey and going to hydrate more and see my rheumatologist about taking Plaquenil. How much can the extra protein be the problem? Thank you.

My mother had breast surgery three years ago and is scheduled for a routine 3-year MRI. The doctor’s office told her that the MRI could be done without contrast but that the contrast would provide more information. My mom’s GFR is around 50 — does the current MRI contrast have any effects on the kidneys? Thank you!

The toxicity of Magnetic Resonance Imaging (MRI) contrast is usually seen with estimated glomerular filtration rates (eGFR’s) of less than 30 milliliters per minute per 1.73 meters squared. A majority of the contrast toxicity for MRI is seen with patients on dialysis therapy. Hence, I would not anticipate a problem with MRI contrast with an eGFR in the 50 range. However, your mother should discuss any concerns with the physician ordering the MRI scan.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Dialysis, GFR, Kidney-Related Health Questions | Comments Off on My mother had breast surgery three years ago and is scheduled for a routine 3-year MRI. The doctor’s office told her that the MRI could be done without contrast but that the contrast would provide more information. My mom’s GFR is around 50 — does the current MRI contrast have any effects on the kidneys? Thank you!

My husband had kidney stones. He was told to avoid tea. What about herbal tea?

I do not advise my patients to avoid tea. I have not found that tea consumption alters the course of kidney stones. Whoever told you to avoid tea, I would check with them as to the reasoning behind this. Some teas contain oxalate, but in very small amounts. I advise following a DASH diet. You can review the DASH diet at: https://www.kidney.org/atoz/content/Dash_Diet

Posted in Ask the Doctor, Diet/Nutrition, Kidney Stones, Kidney-Related Health Questions | Comments Off on My husband had kidney stones. He was told to avoid tea. What about herbal tea?

Can a diabetic kidney be caused by other things besides being diabetic? I was diagnosed with a diabetic kidney, but never had diabetes, and hadn’t taken medication for it. Thank you for your time.

Yes. Diabetic kidney disease has been described in patients who have never had overt diabetes mellitus. This most commonly occurs when someone has a family history of diabetes or obesity associated glucose intolerance.

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, Kidney-Related Health Questions, Risk factors | Comments Off on Can a diabetic kidney be caused by other things besides being diabetic? I was diagnosed with a diabetic kidney, but never had diabetes, and hadn’t taken medication for it. Thank you for your time.

Is it safe to not remove fluid from me at my dialysis treatment? I have low blood pressure all the time.

I am not able to provide medical advice without performing a complete history and physical examination. The removal of fluid should be ordered by your nephrologist. Your nephrologist should provide guidelines for fluid removal in your case. The fluid removal is commonly based on your blood pressure and your physical examination.  

Posted in Ask the Doctor, Dialysis, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Nephrologist | Comments Off on Is it safe to not remove fluid from me at my dialysis treatment? I have low blood pressure all the time.

My friend’s kidneys are failing. Her entire abdomen, arms and legs are severely swollen and her left side is numb. She doesn’t have any insurance and she has been to multiple ER’s. No one is helping her. She is in bad shape trying to find someone to help. Do you know of any doctors that will help?

Neither I nor the National Kidney Foundation provide referrals. If there is a Federally Qualified Health Center (FQHC) in your geographic area, they may be able to provide help. In order to find a Health Center near you, you can go to the HRSA web site at: https://bphc.hrsa.gov/about/index.html

You will need to enter your zip code to find the nearest Health Center to where you live. 

You can also find free health clinics in your area. The local County Medical Society is the best resource for this.

In some cases, your friend may have to apply for Medicaid and see if she can get services through Medicaid in your State. 

Posted in Ask the Doctor, Insurance & Medicare Coverage, Kidney-Related Health Questions, Symptoms and Side Effects | Comments Off on My friend’s kidneys are failing. Her entire abdomen, arms and legs are severely swollen and her left side is numb. She doesn’t have any insurance and she has been to multiple ER’s. No one is helping her. She is in bad shape trying to find someone to help. Do you know of any doctors that will help?