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

Dear Dr. Spry, Is Glutathione safe for PD dialysis patients? Thanks.

Glutathione is a normal constituent of food and is a nutritional supplement that is generally accepted as safe by the Food and Drug Administration. I do not know of any problems with glutathione supplementation for patients on peritoneal dialysis.

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

My grandma is 89 years old and just diagnosed with stage 4 chronic kidney disease. She also has congestive heart failure. Is she too old for at home dialysis?

The decision to perform dialysis therapy is a decision that your grandmother and her nephrologist will have to make together. There is no age limit to starting dialysis. There have been studies that suggest that patients in the older age group (generally greater than 75 or 80) do not extend their life expectancy with dialysis although dialysis can lead to fewer hospitalizations. Dialysis will always lead to an increased burden of care for patients in this elderly group.

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

My 60 yr old brother is on 24 hour dialysis in ICU. The dialysis machine goes down for several hours each day. The nurse said it is because the machine is filtering the toxins and removing excess fluid from his body and toxins clog up the machine. They have to clean it and rewire it to start it again. Does that sound accurate? I can’t help but wonder if it is a faulty machine, inaccurate amount of anticoagulants (or other meds), or not being monitored appropriately. It seems if they call it 24 hour dialysis, it would work for 24 hours a day.

I assume that you are asking about Continuous Renal Replacement Therapy (CRRT) or Slow Low Efficiency Dialysis (SLED). These are dialysis techniques that are used in the intensive care unit (ICU). Despite being continuous, there are a number of reasons why the machine has to be adjusted, re-started and interrupted. In some cases, it has to do with procedures that must be carried out in the ICU. In other cases, the filter experiences some clotting. Other reasons have to do with the vascular access device, that is generally a large bore catheter in the neck or shoulder. Dialysis in the ICU can be very challenging. This form of dialysis is generally performed on patients who are too unstable to be on our conventional dialysis machines. This cardiovascular instability contributes to the problems encountered on CRRT and SLED. While they may call it 24 hour dialysis, the proper name is either CRRT or SLED, and it is subject to interruptions as described above.

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

My blood creatinine is 1.71 and microalbumin in urine is 251. I am also a diabetes patient. I take Metformin and Glynase. Blood pressure is in normal range with the help of allopathic medicines (Telma 40 and Metolar XR 25).

The description that you provide would be most consistent with diabetic kidney disease. Telma (Telmasartan) is a drug often used to treat diabetic kidney disease. I suggest you continue to follow closely with your physician and have blood and urine testing at least annually for your kidney disease.

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

I had Acute Kidney Failure in 2011 from C Diff & shock. I was in the ICU for 11 days. I now see a rheumatologist for fibromyalgia symptoms. My GFR was 51 on routine testing and creatinine 1.1. I am 63. Do you think I need to contact my nephrologist for further testing since I have a history? Do you think it’s from NSAIDS I take for the pain?

Acute kidney injury (AKI) is a known cause of chronic kidney disease (CKD). In your case, you may have partially recovered from the AKI but the use of non-steroidal anti-inflammatory drugs (NSAID’s) can complicate this and further reduce you kidney function. I suggest that you review your use of NSAID’s with both your rheumatologist and your nephrologist.  I would also recommend that you have urine testing for blood, protein and infection.

Posted in Acute Kidney Injury, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Medication and Kidney Function, Nephrologist

I have CKD; right now my gfr is 23, 3 months ago it was 35. What caused the big drop? Can’t seem to get an answer from my nephrolgist, except he’s seen bigger drops and he’s not concerned. Originally 3 years ago GFR did the same thing from 56 – 32 in a month’s time. I thought is was slow progression. I watch my diet, exercise, do not have diabetes, have controlled BP. I do have protein and microscopic blood in urine. I am overweight (about 25 pds). I am working on that. I feel I am doing everything I can and these big drops are scaring me. My Mom (deceased) and older sister both have CKD as well. I’m 65, my Mom was in her 80’s when she started dialysis. My sister is Stage 4 and has been stable for 4 years. I just can’t seem to figure out why my kidney function is declining so rapidly. Can you help me understand?

I am not able to make a specific diagnosis based on the information that you present. Since your mother and sister both have kidney disease, it could be that you have a hereditary kidney disease. In order to know this, you or a member of your family would have to have a kidney biopsy. It is necessary to know the specific diagnosis in order to provide a prognosis for chronic kidney disease (CKD). Sudden drops in kidney function can be related to blood pressure out of control, activation of vasculitis or glomerulonephritis, obstruction, decreases in heart function, drug complications, allergic reactions, infection and many other causes.

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

I have a 22mm kidney stone. So what food should I eat to prevent my kidney from stop functioning and live a healthy life??

I commonly recommend the DASH diet for patients with chronic kidney disease (CKD) and kidney stones. The DASH diet is a low salt diet. You can review the DASH diet on our web site at: https://www.kidney.org/atoz/content/Dash_Diet

A 22 millimeter stone is a rather large stone and should be evaluated by a urologist.

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

I have a stage 3 kidney disease. I was born with one kidney. My remaining kidney has numerous kidney stones and cyst. I just found out the biggest cyst is 7.8 x 5.9 x 6.4 cm. I was diagnosed with Bosniak 2F. This is over half the size of my actual kidney, which is 15.3 cm. I am postmenopausal, but have started experiencing blood in the urine. What would be the prognosis? Can a cyst be surgically removed? Thanks for your response.

The problem that you describe should be evaluated by a urologist. I am a nephrologist and have no surgical expertise. A urologist is a surgeon and deals with complex cysts and stones of the kidney. I recommend that you consult with a urologist.

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

My mom is going through dialysis. She is becoming very weak. She feels very thirsty but can’t drink water. She’s always complaining about her head spinning. Her breathing is difficult and she uses the nebulizer due to drinking small amounts of water. No urination at all. Please help.

I am not able to provide a specific diagnosis based on the information that you present. Your mother needs to have a complete history and physical examination. I suggest that you and your mother consult with the nephrologist who is supervising her dialysis.

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

Dear sir, I am asking on behalf of my brother who is a dialysis patient of CKD. Recently he was not feeling well so we did some blood examinations; his creatinine is 18 and his potassium level is 11. Please help me with some drugs to lower the potassium level. Due to COVID-19 lock-down we are not able to go to higher center to meet the nephrologist. Hope you will help me out as soon as possible. Thank you sir.

Based on the information that you present, your brother should be in the hospital. Despite being in a COVID-19 shut down, your local hospital should be functioning. Your brother should be taken to the emergency room. There are no pills or medicines that will help and hospitalization is recommended.

Posted in Ask the Doctor, Kidney Failure, Kidney-Related Health Questions, Medication and Kidney Disease, Medication and Kidney Function, Treatments