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

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

I have 9 items (Bicarbonate, Sodium, Potassium,Chloride,Glucose, Alkaline Phosphate, Bilrubin,Total Protein and Albumin) which have increased in 2 months of testing. I was initially diagnosed at Stage 2 CKD and am seeing a Nephrologist near his own Dialysis Center. (I am not currently on dialysis) Is this common and normal?

Yes.  It is common for nephrologists to have offices very near dialysis units because as much as 50% of our time is spent evaluating and following up with people who are on dialysis. Having an office adjoining or near a dialysis unit cuts down on travel. We spend the remainder of our time seeing patients in the hospital and patients in our office.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions, Laboratory Testing, Nephrologist

Hi, My brother is 46 and has been detected with CHF after heart attack last month. His LVEF is 30%-35%. He is Type-2 Diabetes and hypertension. However, these are under control now. He is 5.6″ and weighing around 83 kg currently. He just had a creatinine test and it came 2.4 which was 1.21 three months before. What does this mean and if it is a damage to kidney then can it be reversed? Please suggest. Regards.

I am unable to make a specific diagnosis based on the information that you present.  Your brother will need further testing in order to make a specific diagnosis as to the cause of his kidney problem.  Consultation with a nephrologist may be needed.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diabetes, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Serum Creatinine, Urinary Tract Infection/Pyelonephritis

Dear sir I am man and age 51, Bangladeshi. On 30-11-2019 my last creatinine level is 1.55. Is this danger level? How I can control it as 1.2? I am worried. Can you please advise me? How can I control?

In order to complete screening for chronic kidney disease (CKD), you should have a urine test for blood, protein, and infection.  I am unable to make a specific diagnosis based on the information that you present.  You will need to consult with your physician and have a complete evaluation.  Once you have a specific diagnosis, then proper treatment can be recommended.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Serum Creatinine, Urinary Tract Infection/Pyelonephritis

I don’t have diabetes, high blood pressure or high cholesterol, what may have caused my CKD stage 3? My creatinine is 1.11. Thank you.

I am not able to provide a specific diagnosis based on the information that you present.  The two most common causes of chronic kidney disease (CKD) are hypertension and diabetes as you mention.  There are genetic causes of kidney disease, drugs that cause kidney disease, autoimmune causes, birth defects, blockages and many other considerations.  I suggest that you discuss this with your physician.  You should also have urine testing for blood, protein and infection in order to complete your screening for CKD.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diabetes, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Serum Creatinine

I am a 33 year old caucasian male. I have a creatinine level of 1.41 & 1.38 mg/dl (recorded about 1.5 months apart) that was flagged high. Is that of concern? I take a daily protein supplement, physically active, and both these readings were taken in the morning when I didn’t have anything to drink in a 10-12 hours span.

It is difficult to interpret serum creatinine levels when I don’t know the laboratory that performed the test and I don’t know the laboratory normals. These results would likely be above the normal range but I can’t tell for sure. You can use these values and your personal data and enter it into the calculating equation on our web site at:  https://www.kidney.org/professionals/KDOQI/gfr_calculator

You may need to discuss this laboratory result with your physician.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Serum Creatinine

I read that at some point in the past, kidney donations could only be provided by family members. Do you have any idea when this law changed? I can’t find the answer anywhere.

To my knowledge, there has never been a law that kidney donations must be done by a family member. Cadaver donors have been around since the 1950’s and the first successful kidney transplant was done between identical twin brothers (living donor) in 1954. There have been both cadaver donors and living donors since at least the mid 1950’s.

Posted in Ask the Doctor, Donation, Kidney-Related Health Questions, Living Donation, Transplantation

Hello. I have been battling kidney stones for some time now. I was admitted in the hospital June of 2018 multiple kidney stones. And I just saw on my medical records, I have cyst on both kidneys. My problem is my kidney stays swollen up and hurts even more with any activity and it’s getting worse. What could this be and what should I do? I only make $10 per hr and no insurance. So I can not go to a urologist. I haven’t been back to hospital. I don’t know what to do on this. I just want to know kinda what I’m facing if you could help me here. I would greatly appreciate it. Thank You.

Recurring kidney stones are painful. The best treatment for kidney stones is to adopt a very low salt diet.  I am a strong proponent of the DASH diet. You should not use any salt at the table and no salt in cooking. You should avoid fast food. You can review the DASH diet at:  https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
You should also drink at least 3 liters of water daily.  Many people have simple cysts and these are benign findings. These cysts do not require follow up or treatment. They do not cause pain.

If you do all of these things, then you are doing all that you can to avoid further kidney stones.

If the pain continues, then further testing will be required to determine the cause of your pain.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diet/Nutrition, Kidney Cysts, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing

After a double kidney transplant on a 76 year old African American woman in June 2019 in hospital. Is now in hospital Dec 3 for acute edema and heart failure, function of only 25%. They are aggressively using the intravenous water reduction drug. Has loss most of ability to walk because of swollen legs. No prior heart disease before the transplant.

I am unable to make any specific diagnosis based on the information that you present.  The physicians in the hospital would be the best to discuss the diagnosis and treatment alternatives. A biopsy of the kidney transplant may be necessary in order to know the underlying status of the kidneys that were transplanted.  

Posted in Ask the Doctor, Kidney Biopsy, Kidney-Related Health Questions, Transplantation

I had right nephrectomy in 2012. I just recently had a sonogram to make sure my left kidney looks OK (and it does). The last lab results show eGFR non-afr. american at 53, creatinine 1.18, albumin 4.6. Urine test is negative for protein. I tried to figure out that albumin/creatinine ratio, but I am not sure if those two numbers should be combined. My question/concern is if, based on the eGFR value itself, I am already considered to be at the Stage 3?! Thanks in advance.

Removal of one kidney will result in a lower estimated glomerular filtration rate (eGFR) and will actually result in an eGFR that is about one-half of normal.  If the normal eGFR is between 90 and 120 milliliters per minute per 1.73 meters squared, then removal of one kidney should give you an eGFR of between 45 and 60.  As is often the case, it can sometimes be higher and sometimes be lower with variation in the measurement.  Hence, your eGFR would be in the expected range, but if present for more than 3 months, it would fit the definition of Stage 3 chronic kidney disease (CKD) with an eGFR of less than 60 milliliters per minute per 1.73 meters squared. A prior nephrectomy can lead to CKD.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Nephrectomy / One kidney, Serum Creatinine, Urinary Tract Infection/Pyelonephritis

By way of introduction, I a dialysis patient in Mauritius. Been on dialysis for 6 years. My Hgb keeps training low. Despite I do Mircera 75mg twice a month, I need to do blood transfusion. Am of rare cases or 1st case in Mauritius to continuously have menstrual bleeding. Can be twice month for consecutive 15 days, then can stop 5 days and start again. On the Gyn side all tests are OK. I also get side effects and start bleeding when I do Recormon and Eprex. The government supply Recormon is free at the center but I am currently buying Mircera. Due to the recurring bleeding my Hgb is not stabilizing.Your advice would be much appreciated. With thanks and kind regards.

I am not an expert in menstrual bleeding, however, if you are having abnormal bleeding and this cannot be compensated by the Mircera, then the bleeding must be stopped. You should also have careful screening for and replacement for iron deficiency anemia when you have such excessive bleeding. You did not mention your iron levels. These should be measured monthly as long as your bleeding is present.

Has there been any consideration of doing a hysterectomy to stop the bleeding?

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions