Dr Spry I have some symptoms which worry me but do not seem to concern my doctors at all , extreme low back pain for 2 years after 3 nights of excessive beer drinking after which I lost my complexion overnight and many others, something happened that night which left me changed forever . I never have smoked taken drugs nor drink now and have always had a good diet . GFR is reported at over 60 as lab does not specify , creatinine .98 , bubbly urine, twitches, and now lack of sweat and different smelling sweat , also fatigue ,poor sleep and joint pain. Scans 2 years ago were normal as is liver function etc , the really annoying thing is that no one seems to take kidney problems very seriously at all until GFR below 60 even then it’s at a snails pace . My main question to you though doctor is why as I’ve seen you saying here and have read elsewhere is a GFR of 60 considered normal when 59 is panic stations and called stage 3 kidney disease ? Also as far as UK creatinine guidelines go and no doubt US ones too you can be within reference ranges as ” normal ” but still have lost over 50% of kidney function as Edinburgh Infirmary renal dept says on their website ! what kind of normal is that for gods sake ? My doc wasn’t impressed when I pointed that out , do ordinary general doctors really not realise that or are they blatantly lying to their patients telling them they are normal, I don’t know which is scarier. Whichever it is it’s very worrying as obviously the problem wont go away and earlier intervention should result in healthier patients for longer and a vast saving in money in the long run . Most good websites seem to suggest the ” normal” for a healthy young adult is 90 – 120 GFR obviously aging has a declining effect , so why all of the misinformation? I’d be very interested in your opinion. Please don’t palm me off with usual remarks as I know many people would love to have this cleared up. Many thanks in anticipation.

The diagnosis of chronic kidney disease (CKD) includes testing for kidney disease in urine by looking for blood, protein and infection.  It also includes the measurement of the estimated glomerular filtration rate (eGFR) by using an equation that was developed for estimation on the basis of scientific research.  That equation can be found at our web site at:  https://www.kidney.org/professionals/kdoqi/gfr

This particular equation is only accurate for eGFR’s that are less than 60 milliliters per minute per 1.73 meters squared.  There are other tests such as the creatinine clearance, urea clearance, inulin clearance and iothalamate clearance that can be used to measure the GFR that are more accurate for a clearance greater than 60.  These clearance methods are very difficult to perform and subject to some error as well.  Stage 1 CKD is defined as a clearance greater than 90 and abnormal findings in the urine or on the basis of such tests as an ultrasound test or a kidney biopsy.  If urine or kidney tests are abnormal for greater than 3 months and the clearance is greater than 90, this person is said to have Stage 1 CKD.  If the urine and kidney tests are abnormal for greater than 3 months and the GFR is between 60 and 89, this person is said to have Stage 2 CKD.  However, if the eGFR or the GFR are less than 60 but greater than 30for greater than 3 months, then the person is said to have Stage 3 CKD.  Stage 4 CKD is classified as a person having an eGFR or GFR between 15 and 29 for greater than 3 months.  Stage 5 CKD is then an eGFR or GFR less than 15 for greater than 3 months.  These are the means by which we classify CKD.

The classification system does not diagnose the cause of CKD, only the Stage.  It was developed to have a greater understanding of the progression of CKD and not for specific diagnosis of cause.

It is necessary that a nephrologist then arrives at a specific diagnosis for specific treatment of the underlying kidney disease.

I would not consider an eGFR of 59 as “panic stations” but rather an indication of progression for me to then properly diagnose the cause of the underlying disease.  These numbers are not meant to instill fear, but rather allow for meaningful discussion of progression and then diagnosis followed by treatment.

A normal GFR is, indeed, greater than 90 milliliters per minute per 1.73 meters squared.  A person can have a normal GFR and still have CKD.

I hope this is helpful as an explanation as to the usefulness of this classification system that was developed by the National Kidney Foundation in the early 1980’s.  Additional information can be found at the links provided on our web site at:  https://www.kidney.org/professionals/KDOQI/gfr_calculator

 

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