Category Archives: GFR

I had a Kidney transplant 3 yrs ago. Am I still considered to have ESRD?

Technically, you are classified as having End Stage Renal Disease (ESRD) because you required kidney replacement therapy (which just happens to be a kidney transplant). Under the ESRD regulations for treatment of ESRD after a kidney transplant, you are eligible … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Nephrectomy / One kidney, Transplantation

Hello, I am trying to understand effects on the kidney at high altitude. I have read some studies that it can negatively effect the kidneys due to less oxygen and this would cause people with kidney disease to have decreased function. Is this statement true: “Given that many areas of the kidney are marginally oxygenated even at sea level and that kidney disease may result in further renal hypoxia and hypoxia, associated renal injury, there is concern that high altitude may accelerate the progression of chronic kidney disease”?

I am not aware of any information that high altitude impacts the course of kidney disease. There is no information that high altitude further damages the kidney. It is known that high altitude and associated hypoxemia can result in fluid … Continue reading

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

Hello Dr. I am a male 36 yrs old, who recently found out he was born with one kidney. Can you tell me what are the guidelines for creatinine levels for a patient with one kidney? Mines is currently 1.4. Thank You.

Having a single kidney should result in approximately one half to two thirds of normal kidney function. This would mean that there would be an estimated glomerular filtration rate (eGFR) in the range of 50 to 75 milliliters per minute … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, GFR, Kidney-Related Health Questions, Nephrectomy / One kidney, Serum Creatinine

I am a 59-year-old woman with a solitary kidney. I had kidney cancer, and my right kidney was removed 3 years ago. My post surgery bloodwork for the past 2 and 1/2 years has shown my GFR to be in the mid to upper 60’s. But my last blood test 2 weeks ago showed my GFR is down to 46. Creatine is 1.28. My PCP wants to test again in a month. Should I be concerned that my remaining kidney is not functioning properly?

There is always some variability to the estimated glomerular filtration rate (eGFR). This test can vary up and down by 10 milliliters per minute (ml/min) from day to day. With only one kidney, your singe kidney eGFR should generally be … Continue reading

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

GFR is currently the best way to test kidney function. Inulin is the best measure but it is difficult. To simplify, testing doctors use serum creatinine to measure kidney function along with an equation. That is the egfr which is used so widely and also on your site. But it needs additional factors along with it to be considered kidney disease like protein in urine, blood in urine, high blood pressure, abnormal imaging, etc. 24 hour creatinine clearance was the “gold standard” gfr test. Is 24 hour creatinine clearance the “best” and most accurate test? If no, what is?

An inulin clearance or an iothalamate clearance are currently two research standards for measurement of the glomerular filtration rate (GFR). All the rest of the tests have various issues with them and are ways of estimating the glomerular filtration rate … Continue reading

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

On my annual physical yesterday, my general practitioner told me my GFR is 58 and that indicates stage 3 CKD. She didn’t recommend a nephrology consult. Just follow up in one year. Is that appropriate care?

In most cases, primary care physicians (PCP) are able to manage chronic kidney disease (CKD) in the early stages. Stage 3 CKD requires that your estimated glomerular filtration rate (eGFR) be less than 60 milliliters per minute per 1.73 meters … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Hypertension/High Blood Pressure, Kidney Biopsy, Kidney-Related Health Questions, Nephrologist

I was diagnosed with Stage 5 failure in August, 2018. Since then (10 months), I have only consumed about 100mg of calcium a day. My PTH IS 347 and my calcium is 9.0 I’ve begun a low dose of Calcitriol (.25mg, twice a week). I have ten more days until my bloodwork is done again. My understanding (from scouring the internet) is that your parathyroids are constantly monitoring your calcium level. If calcium levels are insufficient, the parathyroids release PTH which causes calcium to be released from your bones (among other things). My PTH could be high because my calcium absorption is low (because my kidneys aren’t converting vitamin D to its active form) – hence the Calcitriol – or my PTH could be high because my dietary calcium is low (because many of the foods I avoid for potassium/phosphorus reasons are also prime sources of calcium). Or, it could be a combination of both. Wouldn’t it make sense to test Active Vitamin D levels before beginning Calcitriol – rather than assuming that a high PTH is due solely to absorption issues? I feel that I likely should be on a calcium supplement but my nephrologist points to my calcium level of 9.0 – which, if I’m understanding correctly, could be the result of calcium being leeched from my bones. When is it appropriate to begin calcium supplements? I just sent a question regarding calcium/calcitriol/PTH but forgot to mention that I’ve maintained a GFR of 12 in the ten months since diagnosis and have not had to begin dialysis. Thank you.

You are dealing with a very complex issue called secondary hyperparathyroidism. This is an area of kidney disease that remains very poorly understood and can be very frustrating to treat. First of all, in patients with chronic kidney disease (CKD) … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Nephrologist

I had labs done today and wanted to know if I should be concerned about kidney damage. My creatinine was 1.13 (high end of range per lab is 1.0), eGFR non AA is 52, Afr Am >=60, UREA Nitrogen (BUN) 10 mg/dl and Bun Ratio is 8.8 mg/dl. I was diagnosed with Graves disease back in October 2018 and I’ve been taking 5 mg of Methimazole daily.

I am unable to make a specific diagnosis based on the information that you present. In order to qualify for chronic kidney disease (CKD) you must have an estimated glomerular filtration rate (eGFR) of less than 60 milliliters per minute … Continue reading

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

Hello, I have had chronic kidney stone disease since about age 23. I’m 48 yrs old now. I have had reoccurring UTIs, hydronephrosis, and/or pyelonephritis about every year or two at most, since my late teens. My family has a very high incidence of renal failure on my paternal side, while the kidney stone disease is very prevalent on my maternal side. I frequently have protein detected in my urine as long as I can remember. I sometimes have very dark bloody to brown urine, very frequently cloudy, and on/off pale foamy urine. I worry that most of this is being passed off as side effects from my kidney stones. I also have hyperparathyroidism secondary to vit D deficiency and I have a genetic Connective Tissue Disease called Ehlers-Danlos Syndrome Hypermobility Type(hEDS) with some overwhelming of Classic Type, Delta Granule Storage Pool Deficiency Platelet Dysfunction, POTS, MCAD, and multiple other Autoimmune Disorders … I’ve seen what used to be called Bright’s Disease show up on numerous family death certificates while compiling our family’s genealogy, so I am concerned that my Urologist hasn’t followed up with more specific testing to evaluate my actual kidney function aside from BMP, CMP, U/A with the frequent culture sent for analysisa. I am concerned especially with my right kidney because it drops a bit low and doesn’t drain well with the ureter arched a bit higher anatomically. I’ve had about 6 ESWL procedures, a Percutaneous Lithotomy( due to high stone volume, 30+ Ranging 1mm-9mm and some high density type stones) with a temp nephrostomy drain/bag, and most recently a Ureteroscopy with laser Lithotripsy and stent placement x 1 1/2 wk(I couldn’t have tolerated the stent any longer), all of these have been about UA showed something new for me that upset, a rare budding yeast which also showed up in a 2nd clean catch sample several days later. I am worried more so because both of my children have hEDS also, they both inherited my Platelet Dysfunction. My son, the younger at 23 yrs, has started passing kidney stones at the same age that I did. My daughter has had a few bad infections also. I can no longer take sulfonamide antibiotics or Nitro furan Antibacterials, due to an allergy to them. Since my last infection and procedure, I have been so tired, bruising, more than usual, with notable Petechia that I don’t recall occurring so much before, itching intensely,(especially at night) and notable increased swelling of my feet, ankles, and sometimes hands. I made an appt with a nephrologist, but have a fairly long wait of a few more weeks until I can get in to see them. I am just concerned and interested in your thoughts. I do have HTN, have had intermittently since my 20’s, was treated in my 30’s with a hydrachlorithiazide until no longer required after significant weight loss with gastric bypass, I have since been treating with a beta blocker in mid 40’s which also treats my POTS …keeping my HR in control. I take sublingual B12 to treat anemia also. I take a lot of medications for my various conditions.

Your medical condition sounds very complex and I am unable to make a specific diagnosis based on the information that you present. Most of the problems that you describe for your kidneys are urological problems and should be addressed by … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, GFR, Kidney Biopsy, Kidney Stones, Kidney-Related Health Questions, Nephrologist, Serum Creatinine

Good morning, this was your response to my question. If the creatinine clearance is high and the elevated serum level is also high why is that? You said it was creatinine generation. Is it due to kidney size at all? I have 10.9 and 10.7 kidney size. I was at 1.7mg/dl and I had eaten a meal with chicken a few hours before. The 1.4mg level was when I was so scared I practically cut out all meat. I am just curious how this can still be normal? Please describe normal for me in Depth. Can normal still be reduced?? How can one have a low gfr and still have normal function that doesn’t make sense. Please explain this to me as well. I appreciate it. Response: If this is the case, then your serum creatinine is elevated because you have an increased creatinine generation rate. This is most commonly due to increased muscle mass as compared to the average individual. An increased intake of red meat can also increase the creatinine generation rate and lead to an elevated serum creatinine. The equations that we use to estimate the glomerular filtration rate (eGFR) are not very accurate or reproducible with values above 60 milliliters per minute per 1.73 meters squared. There are other ways of measuring the glomerular filtration rate but if you are using a serum creatinine and the estimating equation, anything above 60 is considered a normal GFR. Stage 2 chronic kidney disease (CKD) requires a eGFR between 60 and 89 for at least three months AND the presence of abnormal urinary findings (blood, protein, or infection), abnormal ultrasound examination, or abnormal kidney biopsy that is also present for at least three months. For eGFR’s above 60, you need more than just the eGFR in order to diagnose CKD. It is true that an accurately measured glomerular filtration rate (GFR) should be greater than 120 milliliters per minute per 1.73 meters squared.

I am not sure I can explain this any better. If your kidneys are clearing creatinine from your body at an elevated rate, then they are doing their job and they are normal. If your blood creatinine is still elevated, … Continue reading

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