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.

Sir, my family has a history of Medullary Kidney Disease. My function levels have dropped to 45 GFR. No protein; 1.5 creatine. I was told to just continue eat right, exercise. Nothing can be done. Will IV therapy or stem cells repair therapy help my kidneys.

There are a number of different Medullary diseases of the kidney including Medullary Sponge Disease, Medullary cystic disease, Medullary nephrocalcinosis and Dysplastic kidney disease. I am not able to tell what type of Medullary disease that you are referring to. There are no kidney diseases that have been shown to respond to stem cell therapy as of July of 2021. I suggest that you consult with a nephrologist and ask for a specific diagnosis as well as recommendations for treatment.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Medullary Sponge Kidney, Nephrologist | Comments Off on Sir, my family has a history of Medullary Kidney Disease. My function levels have dropped to 45 GFR. No protein; 1.5 creatine. I was told to just continue eat right, exercise. Nothing can be done. Will IV therapy or stem cells repair therapy help my kidneys.

I’m confused, lab work shows high creatinine and kidney ultrasound states I have one cyst on each kidney and that I have critical kidney disease level 3. My doctor doesn’t seem worried, but wants me to go to a Urolgist and won’t authorize me to see a dietician, which is what I want. I wonder how sick am I? Should I simply fast on water and water crackers until the next blood test? I need someone to be honest with me and tell me what to do and eat. I don’t want to need dialysis! Please help. Thank you.

I am unable to make a specific diagnosis of kidney disease based on the information that you present. It is most important that you have urine testing for blood, protein and infection in order to complete the screening for chronic kidney disease (CKD).  

As far as diet is concerned, I am a strong proponent of the low salt DASH diet. You can review the DASH diet at: https://www.kidney.org/atoz/content/Dash_Diet

You will need to discuss your kidney cyst with the urologist. A urologist is a surgeon who specializes in surgery on the kidney and urinary tract. A urologist is the best person to give you an opinion about your kidney cyst.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diet/Nutrition, Kidney Cysts, Kidney-Related Health Questions, Urinary Tract Infection/Pyelonephritis, Urological Issues | Comments Off on I’m confused, lab work shows high creatinine and kidney ultrasound states I have one cyst on each kidney and that I have critical kidney disease level 3. My doctor doesn’t seem worried, but wants me to go to a Urolgist and won’t authorize me to see a dietician, which is what I want. I wonder how sick am I? Should I simply fast on water and water crackers until the next blood test? I need someone to be honest with me and tell me what to do and eat. I don’t want to need dialysis! Please help. Thank you.

My GFR is 28. Down from last month; which was 35. My protein levels are good at 6.6. Should I be concerned?

The falling value for the estimated glomerular filtration rate (eGFR) is of concern and should be repeated. An eGFR of less than 30 is consistent with Stage 4 chronic kidney disease (CKD). I suggest that you discuss this with your physician and ask for a specific diagnosis as to the cause of your CKD. I would also recommend that you have urine testing for blood, protein and infection in order to complete your testing for CKD.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions | Comments Off on My GFR is 28. Down from last month; which was 35. My protein levels are good at 6.6. Should I be concerned?

My last Lifeline Screening showed my eGFR as “abnormal” at 48. I am a 64-year-old female, 5’8.5″ tall, 135 lbs, with low blood pressure, no diabetes, eat very healthy (fruits, vegetables, fish), drink lots of water, but I do not exercise as regularly as I should besides walking. It concerned me when I “Googled” & 48 is the score of an 85-year-old! I did show my results to my primary care doctor but she did not suggest further tests. If you were me, what steps would you take next? Thank you so much for your expertise.

Some of the laboratory screening is not as accurate as one would hope. I would suggest that you have your screening repeated by your physician to include a blood test for serum creatinine and calculated glomerular filtration rate (eGFR). Your screening should also include a urine test for blood, protein and infection. This is the proper way to screen for kidney disease. Some of the free screening tests are not reliable.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Laboratory Testing, Serum Creatinine | Comments Off on My last Lifeline Screening showed my eGFR as “abnormal” at 48. I am a 64-year-old female, 5’8.5″ tall, 135 lbs, with low blood pressure, no diabetes, eat very healthy (fruits, vegetables, fish), drink lots of water, but I do not exercise as regularly as I should besides walking. It concerned me when I “Googled” & 48 is the score of an 85-year-old! I did show my results to my primary care doctor but she did not suggest further tests. If you were me, what steps would you take next? Thank you so much for your expertise.

I had a procedure on Thursday to get a port for dialysis. My hand is numb but hurting and right breast is swollen. Is this normal?

I suggest that you contact the person who placed the catheter or port and express concern about this. I would not expect these symptoms or signs to be present after placement of a dialysis catheter.  

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions, Symptoms and Side Effects | Comments Off on I had a procedure on Thursday to get a port for dialysis. My hand is numb but hurting and right breast is swollen. Is this normal?

My most recent lipid panel results: Cholesterol 220/triglycerides, 72/HDL, 54/VLDL, 13/LDL 153. This was a fasting blood draw. Comprehensive Metabolic panel: Glucose 93mg/dL, BloodUreaNitro 10mg/dL, Creatinine level 0.85mg/dL, BunCreatinineRatio 12, Sodium 141mmol/L, Potassium 3.9, Chloride 100, Co2mmol/L 26, Calcium 9.6 mg/dL, Protein 7.4, Albumin 4.4g/dL, Globulin 3.0 g/dL, Albumin/Globulin Ratio 1.5, Bilirubin Total 0.4 mg/dL, alkaline Phosphate 92 IU/L. Hemogram: WBC 9.2 x10E3/uL, RBC 4.82x10E6/uL, Hemoglobin 14.2 g/dL, MCV 91fL, MCH 29.5pg, MCHC 32.5 g/dL, RedCellDistribution 12.5%, Platelet count 320. On 12-27-17 my HGB A1C was 4.9%, average estimate glucose 94 mg/dL. Hematology WBC 9.57/ RBC 4.04/ HGB 14.0/ HCT 40.7 /MCV 100.7/ MCH 34.7/ MCHC 34.4/ RDW CV12.6/ RDW SD46.6/ PLT 358/ NEUT% 68.9/ Lymph%20.0/ MONO%5.3/ EOS%5.1/ BASO%0.4/ IG%0.3/ nRBC 0.00/ Chemistry: Cholesterol 181/Triglycerides 87/ETOH <10/HDL 50/LDL 120/TSH 2.2955/ T3uptake 32.6/ T4total 6.10/ Co2 26/ FTI 1.99/ AnionGap 12 Glucose 126 /BUN14.74 /Creatinine 0.68 /eGFR<60/ eGFRAA<60/ Total protein 7.6/ Albumin 3.6/ Calcium 9.36/ Alk Phos 80/ Total Bili 0.4/ AST 51/ ALT 46. Can you give me your opinion? Thank you.

I do not identify any kidney disease in the laboratory studies that you present. I do see a mild elevation in the cholesterol and lipid panel. I do not identify any other abnormal laboratory testing

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing | Comments Off on My most recent lipid panel results: Cholesterol 220/triglycerides, 72/HDL, 54/VLDL, 13/LDL 153. This was a fasting blood draw. Comprehensive Metabolic panel: Glucose 93mg/dL, BloodUreaNitro 10mg/dL, Creatinine level 0.85mg/dL, BunCreatinineRatio 12, Sodium 141mmol/L, Potassium 3.9, Chloride 100, Co2mmol/L 26, Calcium 9.6 mg/dL, Protein 7.4, Albumin 4.4g/dL, Globulin 3.0 g/dL, Albumin/Globulin Ratio 1.5, Bilirubin Total 0.4 mg/dL, alkaline Phosphate 92 IU/L. Hemogram: WBC 9.2 x10E3/uL, RBC 4.82x10E6/uL, Hemoglobin 14.2 g/dL, MCV 91fL, MCH 29.5pg, MCHC 32.5 g/dL, RedCellDistribution 12.5%, Platelet count 320. On 12-27-17 my HGB A1C was 4.9%, average estimate glucose 94 mg/dL. Hematology WBC 9.57/ RBC 4.04/ HGB 14.0/ HCT 40.7 /MCV 100.7/ MCH 34.7/ MCHC 34.4/ RDW CV12.6/ RDW SD46.6/ PLT 358/ NEUT% 68.9/ Lymph%20.0/ MONO%5.3/ EOS%5.1/ BASO%0.4/ IG%0.3/ nRBC 0.00/ Chemistry: Cholesterol 181/Triglycerides 87/ETOH <10/HDL 50/LDL 120/TSH 2.2955/ T3uptake 32.6/ T4total 6.10/ Co2 26/ FTI 1.99/ AnionGap 12 Glucose 126 /BUN14.74 /Creatinine 0.68 /eGFR<60/ eGFRAA<60/ Total protein 7.6/ Albumin 3.6/ Calcium 9.36/ Alk Phos 80/ Total Bili 0.4/ AST 51/ ALT 46. Can you give me your opinion? Thank you.

Hi Dr. Spry, I recently had my annual bloodwork done last week, I have been doing annual physicals and bloodwork for the past 20 years. I am 54 years old now. 5 feet seven inches tall and 150 pounds. I run 25-40 miles per week 7-8 months out of the year, and I stay active the other 5 months. My recent blood tests came back with an EGFR of 56 and a creatinine of 1.34. Last year the creatinine was 1.17. Total protein was 7.4 and BUN was 24. Glucose levels 80 mg/dl. Albumin was 5.0. I am resigned to the fact that I have stage 3 CKD. I am scheduled for an ultrasound this week. I am 90 percent vegan in my eating habits. My question is, is there anything I can do? Can my kidney function be improved? I did have my urine tested three years ago and it was normal. Although my urine has always been off and foamy for at least the past 10 years. My question; are there any at all avenues I can explore ie; Mayo Clinic in Rochester, Minnesota or are there any treatments in the medical world that can help this? I would just like to know if I can improve my overall health and reduce my mortality rate. Any advice would be helpful. Thank you very much.

The diagnosis of Stage 3 chronic kidney disease (CKD) requires two separate tests with an estimated glomerular filtration rate (eGFR) of less than 60 milliliters per minute per 1.73 meters squared and these tests should be at least three months apart. A urine test that shows blood protein or infection can act to confirm the diagnosis of CKD. Hence, you may need further testing in order to confirm the diagnosis of CKD.

The treatment of CKD first requires a specific diagnosis in order to determine the specific treatment. Once you have CKD, then the goal is to prevent further damage to the kidneys. You should have a normal blood pressure of less than 130/80. You should not smoke. If you have diabetes, then this should be carefully controlled. 

It sounds like you are doing most everything you can do to live a healthy lifestyle. The ultrasound that you mentioned can help to evaluate the kidneys for reversible kidney disease such as blockage or other acquired kidney disease.  

I do not have any other suggestions about treatment based on the information that you present.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diabetes, GFR, Hypertension/High Blood Pressure, Kidney-Related Health Questions | Comments Off on Hi Dr. Spry, I recently had my annual bloodwork done last week, I have been doing annual physicals and bloodwork for the past 20 years. I am 54 years old now. 5 feet seven inches tall and 150 pounds. I run 25-40 miles per week 7-8 months out of the year, and I stay active the other 5 months. My recent blood tests came back with an EGFR of 56 and a creatinine of 1.34. Last year the creatinine was 1.17. Total protein was 7.4 and BUN was 24. Glucose levels 80 mg/dl. Albumin was 5.0. I am resigned to the fact that I have stage 3 CKD. I am scheduled for an ultrasound this week. I am 90 percent vegan in my eating habits. My question is, is there anything I can do? Can my kidney function be improved? I did have my urine tested three years ago and it was normal. Although my urine has always been off and foamy for at least the past 10 years. My question; are there any at all avenues I can explore ie; Mayo Clinic in Rochester, Minnesota or are there any treatments in the medical world that can help this? I would just like to know if I can improve my overall health and reduce my mortality rate. Any advice would be helpful. Thank you very much.

I have a history of kidney stones, and for the past few years, my Creatinine levels have been really high 1.35 (7-23-21), 1.11 (4-9-21), and 1.50 (8-25-20). I am worried that none of my doctors have brought this to my attention, and I would like to know if this is something I should be concerned about?

I am not able to provide a specific diagnosis based on the information that you present. In order to complete screening for underlying chronic kidney disease (CKD) it is important that you have urine testing for blood, protein and infection.  

I also am unable to make a specific diagnosis as to your kidney stone disease. There are some kidney diseases associated with stone disease and this should be investigated.

I recommend that you review your concerns with your physician.  

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney Stones, Kidney-Related Health Questions | Comments Off on I have a history of kidney stones, and for the past few years, my Creatinine levels have been really high 1.35 (7-23-21), 1.11 (4-9-21), and 1.50 (8-25-20). I am worried that none of my doctors have brought this to my attention, and I would like to know if this is something I should be concerned about?

Some labs are okay; others are not. I’ve had over 6 months of high urine rbcs, and high urine proteins. Nobody has said anything and I’ve complained of kidney pain. They looked at antibodies and only SSdna was positive and high at 88; everything else is normal for ANA. My random creatinine in 1 urine sample was 120.2. Is that bad? High albumin/globulin, low calculated osmolality, low bun/creatine, high basophils. Nobody is giving me answers. What is going on?

I am not able to provide a specific diagnosis based on the information that you present. I do not recognize any kidney disease based on the information that you present. There are no normal values for a random urine creatinine as this value is used to judge other constituents of the urine such as protein, sodium, potassium and other chemicals in the urine. A single stranded anti-DNA antibody (SSdna) is of no consequence.  

I suggest that you continue to consult with your physician about your symptoms and your concerns.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions | Comments Off on Some labs are okay; others are not. I’ve had over 6 months of high urine rbcs, and high urine proteins. Nobody has said anything and I’ve complained of kidney pain. They looked at antibodies and only SSdna was positive and high at 88; everything else is normal for ANA. My random creatinine in 1 urine sample was 120.2. Is that bad? High albumin/globulin, low calculated osmolality, low bun/creatine, high basophils. Nobody is giving me answers. What is going on?

What prescription meds for arthritis can be taken while on dialysis? I have about 15% kidney function now and been on dialysis 6 years. I’m 86 yrs old in reasonable health, but arthritis is taking over my body. Help.

I am not able to recommend prescriptions medication without performing a complete history and physical examination. Note that in my patients, I generally recommend topical agents for arthritis pain. Any topical agents should be safe for someone on dialysis except that I would not apply the topical agent on or near your fistula as this could create irritation and potential for infection.  

Any other agent must be recommended by your nephrologist. Not only must your nephrologist consider if an arthritis medication is safe for you on dialysis, he or she must consider if that drug will have any interaction with any other drugs that you may be taking. I suggest that you discuss your concerns with your nephrologist.  

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Medication and Kidney Function, Nephrologist | Comments Off on What prescription meds for arthritis can be taken while on dialysis? I have about 15% kidney function now and been on dialysis 6 years. I’m 86 yrs old in reasonable health, but arthritis is taking over my body. Help.