Category Archives: Kidney Biopsy

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 … Continue reading

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

I have just posted my question yesterday and you told me that all the sympstoms I stated seems to be not related with CKD as CKD Stage 3 usually doesn’t have any symptoms yet. He has undergone kidney biopsy last December and we are told by the doctors that he has CKD Stage 3 and only 48% of his kidneys is working. As you have said that it may imply other severe kidney diseases, why is it that the biopsy detected that he has CKD? Thank you.

The kidney biopsy is the definitive way to diagnose chronic kidney disease (CKD) and tells you what disease process is causing the kidney damage.  The Stage of CKD is determined by measurement of a glomerular filtration rate (eGFR) and performance … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Kidney Biopsy, Kidney-Related Health Questions, Nephrotic Syndrome, Symptoms and Side Effects, Urinary Tract Infection/Pyelonephritis, Urological Issues

My wife, 66 yo, was recently diagnosed with kidney disease early stage kidney failure. Her protein numbers, etal remained somewhat steady for 6 months but on her last two labs they have shot up so the doctor ordered more aggressive treatment which includes prednisone and 2 chemo sessions. She never had a kidney biopsy and cancer has never been diagnosed. In fact by process of elimination the diagnosis is hereditary and high blood pressure. My wife did not ask why chemo if no cancer but I am really upset about it but don’t want to alarm her. Could there be another reason for the chemo? Thank You.

In order for your wife to receive chemotherapy for kidney disease, it is commonly necessary for your wife to sign a permit that she has received informed consent about the use of chemotherapy.  If your wife has not received informed … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney Cancer, Kidney-Related Health Questions, Lupus, Nephrotic Syndrome

Doctor glad to greet you, My question is that I have creatinine at 2.70 and glomerular filtration at 20%. Are these values of chronic kidney disease very alarming? To start with the transplant? I don’t have diabetes or high blood pressure, my sodium tests partial urine glucose are fine. Under the creatinine 2 points and glomerular filtration rose 1 point I do not know how I can know what happened to my kidneys I can not biopsy because my kidneys are small, Doctor you can say about it? Thank you

Your estimated glomerular filtration rate (eGFR) is 20 and this would be consistent with Stage 4 chronic kidney disease (CKD).  When your eGFR is less than 20 milliliters per minute per 1.73 meters squared, you could be eligible to apply … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diabetes, GFR, Hypertension/High Blood Pressure, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Transplantation

Hello Dr. Spry I’m 36 years old , I underwent pre-emptive kidney transplant on 17/4/2019. I was diagnosed with medullary sponge kidney since 2005 ( as congenital case ) My GFR was 55 ml/Min at Cr 2.0 mg/DL The progression of my case took almost 14 years until Feb, 2019 where my GFR dropped to 15ml/Min at Cr 6.6 mg/DL My brother donated his kidney and the transplant was successful. I was discharged to ICU then to my room after 24 hours at Cr of 1.1 I started with immunosuppressive agents immediately Prograf ( Tacrolimus) 7 mg daily Cellcept ( mycophenolate mofetil) 500mg *4 Prednisolone 15 mg daily By August ,2019 creatinine jumped to 1.5 My nephrologist asked for U/S and it was normal Then he asked for biopsy that showed BK virus infection. In parallel , I was suffering from severe diraheaa caused by Mycophenolate ( cellcept) And I was admitted to hospital for 48 hrs where I underwent biopsy and colonoscopy since my weight decreased significantly. During my stay in the hospital,, I was connected to normal saline IV Creatinine dropped to 1.3 Accordingly , nephrology team suggested that I suffered from dehydration due to diraheaa . So they lowered the mycophenolate dose and raised the steroid and Tacrolimus. My weight started to increase . Diraheaa immediately stopped and creatinine remained 1.3 and my overall health improved. Last week Creatinine jumped to 1.6 Prograf level 8.6 ng/dl Hb 13 My nephrologist informed me that he had no significant illustration to this case. He asked me to repeat the Cr and prograf level next week , if it remained 1.6 or more He will ask for U/S and if it was normal he will go to second biopsy. By next week I will finish 6 months ( post transplant). On the other hand,, my brother ( Donor) was discharged at Creatinine 1.3 One month later it was 1.5 , and since that date it remained 1.5 He is not suffering from any illness and his overall health is perfect He is 50 years old ( non diabetic , non HTN) His medications are : Aspirin every other day Crestor 10 mg daily My questions are : 1. are these complications post transplant normal ? Especially I never undergo dialysis? HLA 70% , lymphocytotoxicity ( negative) 2. is it normal or accepted to go for second biopsy? 3. What is your assessment to my case , and your recommendations? 4. What is your assessment to my brother case , and your recommendations? Thanks a lot for your efforts , waiting for your kind reply. Regards.

I am unable to give medical advice without performing a complete history and physical examination.  The course that you describe for you post transplant events are not uncommon.  The first six months after a transplant are generally the most unpredictable … Continue reading

Posted in Ask the Doctor, Diabetes, Kidney Biopsy, Kidney-Related Health Questions, Symptoms and Side Effects

I’ve been told I have stage three kidney disease. Are there stages 1 and stage two? If so, what are the numbers for each stage?

Stage 1 & Stage 2 chronic kidney disease (CKD) require that you have abnormal findings in your urine or on other tests such as a kidney ultrasound or kidney biopsy. These abnormal findings must be present for at least three … Continue reading

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

Is kidney biopsy needed if the creatinine levels didn’t go above 1.5x? Normal urine test, normal ultrasound, no symptoms?

A kidney biopsy is indicated when there is kidney disease present that cannot be explained by the usual diagnostic criteria. A kidney biopsy provides a specific diagnosis of kidney disease so the specific treatment can be recommended. I suggest that … Continue reading

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

A kidney biopsy says that I have hyperfiltration injury. What is that? I am on more Losartan to lower blood flow in kidneys. My weight is great, I exercise regularly, drinking 64+oz of water a day and limiting my potassium.

Hyperfiltration injury is generally described as enlarged kidney filters (called glomeruli). It also can show scarring of the filters that we call “glomerulosclerosis”. It can be seen in patients who have a low birth weight, are born prematurely, have diabetes, … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diabetes, Hypertension/High Blood Pressure, Kidney Biopsy, Kidney-Related Health Questions, Nephrectomy / One kidney

Hi Dr. I’m really concerned about my mom. From March through mid-July her creatinine went from 1.06 to 1.78. She is 82 (GFR now 26 and now in stage 4). The acceleration is alarming to me, but her nephrologist doesn’t seem concerned. I am concerned at this rate if it continues, I’m thinking stage 5 in three months or so. Nephrologist doesn’t think the risks of a biopsy are worth it. My big concern is that it may be something that can be changed now before more permanent kidney damage is done (if it isn’t due to that now), but as I said, Nephro not very open to digging . . . and I understand to a degree, especially with some things she went through last year, but what is the alternative, renal failure and dialysis? Do you think this rate of decline is fairly normal or more alarming? What are your opinions on the risks of biopsy? And I realize all you can say are your opinions so I won’t hold you to it if, in our case, you are wrong. Just trying to get an idea if this is normal protocol? Do nothing and wait to see how bad it gets? Is there any other less invasive tests that I can ask for?

I am unable to provide a specific diagnosis based on the information that you present. The best course would be for you to have a conversation with the nephrologist about the specific diagnosis related to your mother’s kidney disease and … Continue reading

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

Hi Dr.- I am a 36 year old female. I had a history of hypertension for the last 10 years. A UTI post I delivered baby (last 7 years). In Feb this year I got an infection again where budding yeasts present morphologically consistent with Monilial organism were found. My gynecologist suggested I undergo some blood tests done. As per the reports, my creatinine was 1.41 mg/dl and uric acid was 6.3mg/dl. Even my Liver profile tests showed high levels of ALP 170u/l, GAMMA GLUTAMYL TRANSFERASE (GGT) 109u/l, ASPARTATE AMINOTRANSFERASE (SGOT ) u/l. I was then diagnosed with CKD. My creatinine levels sometimes have dropped to 1.19 and even uric acid levels were normal. However, now creatinine level has reached to 1.43 and uric acid to 6.9. I got even a DMSA scan done 3 months back and as per the reports both kidneys are normal in size and position with irregular cortical margins and mildly impaired cortical function and small areas of cortical scarring seen in lower pole region. No one has told me till yet why I have CKD and how serious my current stage is. I have just been told to consult with a renal dietitian to keep my kidney functioning better. Can you please suggest how many years I have without the need of dialysis/transplant and if my levels can stop here only? My BP is under control and on a average its 130/90. I haven’t had a UTI in 2 months. Also, during the last 10 years, I was on a lot of NSAID medications due to headache problem but have stopped having them since Feb this year. Your guidance here will be appreciated a lot as I am too young to have a disease like CKD.

I am unable to make a specific diagnosis based on the information that you present. In some cases a kidney biopsy is necessary in order to be sure of a specific diagnosis as far as your kidney disease. I am … Continue reading

Posted in Ask the Doctor, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist