Category Archives: Kidney Biopsy

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

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

Hi Doctor, I’ve been struggling with microscopic hematuria and proteinuria for 15 months (ACR anywhere from 0.3 mg/ mmol- 1g). My urine Creatinine is a bit higher at 25 mmol and urine Albumin 68mg. I’ve also been diagnosed with anemia and low hemoglobin. My doctor is suggesting a nephrologist with my family history of kidney failure, but is it necessary? My EFGR is healthy and my serum creatinine levels go from 77-88. I’m a 29year old female if it helps?

I would trust your physician and seek referral. I am unable to make a specific diagnosis based on the information that you present. Blood and protein in the urine are likely signs that you may have kidney disease. In some … Continue reading

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

My creatinine is 3.47 and my BUN is 23. I am currently hospitalized and going for kidney biopsy on Monday. Do I have CKD? The doctors are dumbfounded due to lots of liquids my kidneys have gotten worse as far as function etc.

The kidney biopsy will give you a definitive answer. Chronic kidney disease (CKD) implies that kidney function has been low and stable for three months. If you are having a kidney biopsy, this suggests that there is an element of … Continue reading

Posted in Acute Kidney Injury, Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions

Normal Kidney function is considered anything over 60 gfr. But what does normal imply. For example say you have a 65 gfr vs a 75 gfr. “Normal” does that mean like yea its kinda working but not great. Because shouldn’t you have 100 gfr? Like how can above 60 be normal. Shouldn’t 60 gfr be considered reduced? Or is the formula inaccurate and can misdiagnose unless its under 60 gfr. Because the gfr is low due to serum creatinine and equation but the doctors say there is no kidney disease and things are normal. Your website says anything under 90 is stage 2 kidney disease. How is that normal? It just doesn’t make much sense. Thoughts on this

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 … Continue reading

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

Hello Dr. Spry: I am a 78 year old white male with creatinine of 2.99. I recently had a Kappa/Lambda Light Chains Free With Ratio, Serum blood test. Kappa Light Chain, Free Serum results 61.5 (ref range 3.3-19.5), Lambda Light Chain Free Serum results 35.3 (ref range 5.7-26.3), Kappa/Lambda Free With Ratio results 1.74 (ref range 0.26-1.65). Should I be concerned about these elevated numbers?

It is difficult to tell. In patients with plasma cell disease and the possibility of multiple myeloma, one of the light chains is usually elevated but not both. It will be necessary to have further testing. You will likely need … Continue reading

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

Can I find any kind of kidney disease if I do a serum creatinine & r/m/e test?

Performing a blood test for serum creatinine and calculating an estimated glomerular filtration rate (eGFR) as well as performing a routine urine test with microscopic examination (r/m/e) is one way to diagnose chronic kidney disease (CKD). In some cases, the … Continue reading

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

Hello Dr Spry. I am living in the U.S. My Father is a kidney transplant patient (He lives in India). He had his transplant in 2010. Since then he is on his daily medicines and routinely does his blood tests. Lately my Father’s creatinine levels have increased from being at 3.5 to 4.5 mg/DL. Though doctors are changing the dose of his medicines, still they are not making much of a difference in his creatinine levels. I would like to take your consultation on this. Is there any treatment he could undergo? What could be done at this point?

I am not able to make treatment recommendations without performing a complete history and physical examination. In some cases a transplant kidney biopsy may be necessary in order to provide a specific diagnosis for the kidney graft failure, as well … Continue reading

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

Hello. Two years ago I became seriously ill. I found out that I had MGUS plus elevated kappa light chains = 23.6 and elevated kappa/lambda Ratio = 1.7. My numbers are now K/L ratio = 3.3 and light chain is 56.7. Which is more than double what it was before. I have taken every blood test under the sun. Hematologist says MGUS is gone when I was told just 2 1/2 weeks ago it was still stable. Now the light chains are spilling into my urine and before I was told this, I have been having throbbing dull pain on my left side. Can light chains give me symptoms even though my kidneys are fine? I was told to wait a month before I was checked because Hematologist wanted to check to see if my anemia was better. Should I wait and does anemia affect these protein numbers?

This is a complex problem and there are no right or wrong answers. Monoclonal Gammopathy of Unknown Significance (MGUS) is usually a benign disease and should not cause pain or discomfort in your kidneys. In most cases, the hematologist is … Continue reading

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

Can you have CKD with no protein in your urine? If so what specific type of disease would it be and what would the reasoning be for CKD without protein leakage?

Chronic kidney disease commonly is associated with reduction in the estimated glomerular filtration rate (eGFR), abnormalities of the urine (including protein, blood or infection) or abnormalities of kidney structure such as seen on an ultrasound (polycystic kidney disease) or on … Continue reading

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