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

Dear Doctor, I have had MPGN I since I was 13. I am now a 47 year old white male. My recent tests show that I have a 1.2 creatinine level, a 1.3 Cystacine level and a high level of 450mg of protein in my urine. The GFR was 57.2. I currently take some Enalapril and HCT. I’m scheduled to have a biopsy soon and I wondered what would be your protocols with those numbers? I’ve had this for 35 years now. Is there any new treatments you would recommend I speak with my nephrologist about? Many thanks!

Membranoproliferative Glomerulonephritis (MPGN) is currently used as a way of describing kidney injury with immune complex mediated kidney disease. Today, we do not commonly categorize the disease into Types I, II, and III. The fact that you have sustained kidney function for 35 years is a testament to the treatment you have received and that this disease is likely an idiopathic form of the disease. In most circumstances, the underlying cause of the MPGN becomes known and this cause is treated. Diseases such as Dense Deposit Disease (DDD) and complement mediated disease can have particularly poor prognosis.

A kidney biopsy may confirm or modify the original diagnosis of MPGN. This could lead to a change in management. Congratulations on doing so well with a very difficult form of chronic kidney disease (CKD).  

Hello doctor, what is the full managment in front of a patient with a nephrotoxicity due to Non-steroidal anti-inflammatory drugs?

Non-steroidal anti-inflammatory drugs (NSAID’s) can cause kidney disease by either acute kidney injury or chronic kidney disease (CKD). Long term use of these drugs can be associated with progressive kidney disease. Hence, the best treatment is to absolutely avoid these NSAID’s such as Ibuprofen, Advil, Motrin, Aleve and Naproxen. Once kidney damage is done by these drugs over several months to years, the kidney disease is not reversible and in some cases can progress to kidney failure and the need for dialysis or transplantation.  

I have stage 3 CKD. I would like to know if I can take Alli 60mg? Thanks.

Alli (Orlistat) is a weight reduction medication that should not interfere with kidney function. It can cause diarrhea, which can lead to dehydration. Alli can also interfere with other drugs that you are taking. Hence, you should still check with your physician about the safety of using this drug.  

I have recently been diagnosed with CKD with an atrophied right kidney. I cannot take anti-inflammatory med such as Ibuprofen and Tylenol does not help much with my arthritic knees and back. Would I be safe to use CBD creams and oils?

Topical agents should not have any ill effects on your kidneys. I have no specific experience with CBD but most other topical agents should be safe to apply directly where you are having the discomfort.

I pass water about 12 times a day from 3am until bedtime approximately 9pm. Do I have an infection?

I am not able to provide a specific diagnosis based on the information that you provide. Urinary infection in a male is uncommon. Urinary frequency can be normal but it may also mean a problem is present. This partially depends on how much fluid you are drinking in a day.  

Dear Sir, my wife (50 years old) only has one kidney. Left kidney was removed on 2013 due to cyst. She has ovarian cyst also. At this time period she feels severe pain. What should she do? Regards.

Kidney disease will not commonly present with pain. I would first recommend that your wife be examined by her Primary Care Physician (PCP) or her Gynecologist. Since these painful episodes occur with menses (period), it is much more likely that the pain is the result of ovarian or uterine events. I suggest your wife have a full examination as to the cause of this pain.

I have been diagnosed with significant hydronephrosis with outflow tract obstruction. I have been sent to a surgeon who says I have a vein crossing the ureter, causing the obstruction of kidney flow. He has only done 15 of these surgeries and I didn’t feel confident in his presentation. How do I find another specialist who truly has done multiple surgeries? Thank you.

The problem that you describe is a urological problem. The problem that you describe is a relatively rare event, when the vein crosses the ureter and frequently causes pain and some blood in the urine. I would suggest that you discuss your concerns with your primary care physician (PCP) and ask for a second opinion from another urologist. Alternatively, you should request a consultation with another urologist at a local University Hospital and see if they have more expertise in this area.

I recently got my blood test results. I had fasted; my blood sugar was 154, creatinine was 1.62 and BUN was 28. I am on the following meds: Glymeperide 1 mg, Amlodopine 5mgs, Metformin 1000 bid, Lisinopril HCTZ 20-12.5, Simvastatin 20 mgms, baby aspirin 81 mgms. I am getting a renal ultrasound on Mon. May 10. After results, should I see a nephrologist? I am strictly adjusting my diet. Cutting sodium down to 1500-2000 mgms daily. I have not drank enough water for last year. Would I be able to bring down the BUN and creatinine levels? I had a large kidney stone attack in 2010 and went through two. Also on Centrum silver multivitamin, watching protein, potassium and phosphorous. Any other suggestions at this time? Thank you Doctor, Sincerely.

I recommend that you have a urine test for blood, protein and infection. You should have a urine for microalbumin to creatinine ratio (ACR) to evaluate your diabetes and any effect on the kidneys.

Since you have diabetes, it is important to control your blood pressure and your diabetes. Your HgbA1c should be between 6.0 and 7.0%. Your blood pressure should be less than 130/80. You should not smoke and you should maintain a healthy body weight with diet and exercise. You should avoid non-steroidal anti-inflammatory drugs (NSAID’s) such as Ibuprofen, Advil, Motrin, Aleve, and Naproxen.

If you are well managed by your primary care physician (PCP), then seeing a nephrologist may not be necessary. If your PCP feels that he or she needs further consultation, then referral to a nephrologist can be considered.

What can be used to prevent nausea and vomiting at night?

I am unable to recommend medical treatment without performing a complete history and physical examination. It is important to know what is causing the nausea and vomiting. In most cases, understanding the cause of the nausea and vomiting is important to prescribing the proper treatment.

What foods should I consume to keep my stage 3 CKD from getting worse?

I am a strong proponent of the DASH diet. I suggest you review the DASH diet at: https://www.kidney.org/atoz/content/Dash_Diet