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 am a 72 year old female with CKD stage 3. I take Benicar 5mg bid. I eat based on the DASH diet plan. I am vegan, no processed soy. I exercise 30-45 min 5 x week. My B/P is 124/94. Is this reading harmful? What should a good reading be?

For patients with chronic kidney disease (CKD), I typically recommend blood pressure control to less than 130/80. Your diastolic blood pressure is slightly high, but I generally do not stress the bottom or diastolic pressure. I recommend continued monitoring of your blood pressures at home.

Posted in Ask the Doctor, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions

Two years ago my GFR was 80 and now it is 57. What could cause this? I am 54, of average weight and I exercise regularly but not at a high intensity. I drink plenty of water and I generally feel good. I am being treated for breast cancer, however my creatinine was at 101 last year, prior to treatment and it was at 86 in 2018. It is currently 102. On another note, my father passed away from kidney cancer at age 70. Should I be concerned about these numbers? Thank you!

I am unable to make a specific diagnosis based on the information that you present. There are some chemotherapy drugs that can be toxic to the kidneys. You may need further testing. I suggest that you discuss this with your primary care physician (PCP) or your medical oncologist who is treating your breast cancer. Kidney cancer should not cause a loss of kidney function unless one kidney is surgically removed for the cancer.

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, GFR, Kidney Cancer, Kidney-Related Health Questions, Medication and Kidney Function

How concerned should I be? In March 2018 my eGFR non-AA was 55, and in Oct 2018 it was 62. In Oct 2019 it was 56 and in Aug 2020 it was 58.

I am unable to establish a specific prognosis without performing a complete history and physical examination. All of the numbers that you provide are within the range of normal laboratory variation for the estimated glomerular filtration rate (eGFR) testing. Hence, the range of your recent kidney function is likely in the range of 55 to  60 milliliters per minute per 1.73 meters squared. This would be consistent with Stage 3 chronic kidney disease. I suggest that you discuss this with your physician.

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

My son was admitted to a children’s hospital (he was 14 at the time) for severe anemia (his numbers were 1.6, I think). He had enlarged liver and heart and his lungs were squished due to his heart. Since then, he has had 6 echos, been put on iron supplements (and vitamin c supplement), heart medication (high blood pressure) and an inhaler. To date (August 3rd 2020), my son has been released from cardio care (been with out blood pressure meds for a year, heart is back to normal and no more high blood pressure) and has been cleared from his hematologist (has been without iron supplement for over a year and has maintained a 13.6-13.8 iron level). He was given an ultra sound before leaving the hospital (they did every test to him to find out what was causing everything). At the ultra sound he was found to have cysts on his kidneys. The nephrology department at the hospital said he was fine and a lot of people get kidney cysts; you just don’t find them til later in life when they can be a problem. We have gone to a nephrologist 3 times now and he said “due to a potential anomaly” my son could possibly have ARPKD. There is one person on one side of the family with kidney disease and no one else. My son has no symptoms of ARPKD. His high blood pressure was because his heart was so large and has since settled and went back to normal. I found out at our first meeting with this guy that my son’s kidneys were enlarged. Sorry it’s taken this long, but here’s my question: all of this transpired in the time-span of a year and up until that point we had no indications that anything was wrong with him. Is it possible that the enlargement of the kidneys or even the cysts or both could be a direct result of the severe anemia? Thank you for your help.

I am not aware of any evidence that severe anemia can cause cysts on the kidneys. Autosomal recessive polycystic kidney disease (ARPCKD) is a genetic disease of the kidneys and sometimes of the liver, so as to cause cysts and scarring of both kidneys and sometimes the liver. The anemia you mention can cause heart disease as you mention. The diagnosis of ARPCKD is usually based on family history, ultrasound appearance of the kidney, and sometimes it is necessary to get genetic testing to confirm the presence of ARPCKD. ARPCKD often has not symptoms until later in life when the kidneys begin to fail. Hence, your son may have no symptoms at the present time and ARPCKD usually is found by incidental ultrasound examinations done for another purpose and is an unexpected finding. You may want to discuss genetic testing with your physician and pediatrician.

Posted in Anemia, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney Cysts, Kidney-Related Health Questions, Pediatric Issues, Polycystic Kidney Disease

Good morning, doctor, I would like to know your opinion on which medicines are useful for COVID in patients with chronic kidney disease. What can you recommend and what foods or vitamins can raise the immune system? Thank you.

There are no specific medications approved to prevent COVID-19 infection in patients with chronic kidney disease (CKD). It is important to wear a mask in public, wash your hands, stay away from crowds (especially indoors), and stay away from people who are ill. I am not aware of any foods or vitamins that raise the immune system. Vaccinations for flu and pneumonia will raise the immune system. I recommend 150 minutes of extra physical activity every week and I am also a strong advocate for the DASH diet. You can review the DASH diet on our web site at:  https://www.kidney.org/atoz/content/Dash_Diet

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Kidney-Related Health Questions

Good evening, my grandmother who lives in another country has been doing dialysis, and before she went on it, she was healthy but recently she has acquired dementia on her third round. Is this normal?

Dementia has been reported after long term dialysis but should not occur after only three sessions of dialysis. I believe you should discuss your concerns with your mother’s nephrologist. Your mother’s nephrologist should be able to offer an explanation about your mother’s situation.

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

I have had severe kidney pain on my left side only. I have had many kidney stones, but cannot figure out why my pain is so bad. I also have nausea, vomiting, and fatigue. Please help!

In order to decrease the frequency of kidney stones, I recommend the DASH diet and drinking lots of extra water. The DASH diet has been shown to decrease the number of kidney stones that you pass. You can review the DASH diet on our web site at: https://www.kidney.org/atoz/content/Dash_Diet

Kidney stones may cause a great deal of pain. I am unable to make any other diagnosis based on the information that you present. I recommend that you have further examination in regards to your pain and may need to have either ultrasound or computerized tomography (CT) scanning to determine if stones are causing your pain.

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

My husband was advised he has damaged his kidney from his alcoholism (he’s in denial and still drinks, but has cut back). He’s having issues with bed-wetting and seems to think it’s unrelated. Could the bed-wetting be related to his alcoholism and damaged kidney? Will this possibly lead to incontinence? Thank you!

Alcoholism can cause kidney disease and when it does so, this can be life threatening. The urinary incontinence is more likely related to the intoxication and mental status changes associated with alcoholism. As he damages his kidney function, this will typically lead to less and less urine production and accumulation of more fluid in his abdomen (ascites) and increasing swelling in his legs (edema).

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Kidney-Related Health Questions, Urological Issues

My Wife, 67, has well-treated HBP on Amlodipine/Olmesarten with HCTZ. Last year’s routine eGFR went from 64 to 52 this year. She is non-diabetic, slightly over weight; also on Lovastatin, Pepcid – good lipid profile on Rx. Always athletic. No edema, muscle cramps. No elevation of enzymes, Ca or K. Work-up?

I am not able to provide a specific diagnosis based on the information that you present. I would also recommend urine testing for blood, protein and infection in order to complete her examination. She also could benefit from a kidney ultrasound to examine her kidney’s size and shape as well as rule out blockage of the kidneys. I recommend further consultation with her physician.

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

Today, my uncle was just removed from the kidney donor list. Why? I am not exactly sure. I want to know: 1) What is going to happen to him now? 2) Is he going to die? I am also wondering what to say to him. He is really depressed as you can imagine, and I am at a loss for words. Please do not post my name as he hasn’t told me himself yet.

I would have no way of determining your uncle’s prognosis without performing a complete history and physical examination. There are many reasons why someone could be removed from the transplant list including heart disease, underlying malignancy, non-adherence to his treatment schedule, underlying infection, or other complicating underlying medical problems. I can only suggest that you wait until your uncle confides in you and then provide some sympathetic listening.

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