Category Archives: Laboratory Testing

My CMP w/ eGFR shows Bun/creatinine ratio of 30.0 (the reference range shown on results is 5.0-25.0.) I know I don’t drink enough water and I had been sick with bronchitis and congestion in my chest just a few days prior to the test. I only had lab work done because my sister had clear cell renal carcinoma and had a kidney removed last summer. Her surgeon told her it was a good idea for any siblings to have at least a sonogram of the kidneys. The trigger for finding her cancer was a routine health exam that showed microscopic blood in her urine. There is no other family history of cancer. I’m not really alarmed about this and all other results of my test are in normal range. I also had a CBC w/auto diff W/PLT same day and my MO% was high 19.3 (reference range 5.5 – 11.7) as well as the MO# 1.6 (ref .3 -.8). I would like to get your opinion on these lab results. When the doctors office called they said my lab was ok. Can you give me your initial impression? I do plan to have the sonogram soon.

I am unable to make a specific diagnosis based on the information that you present. The Blood Urea Nitrogen (BUN) to creatinine ratio is a calculated value that is not helpful in the diagnosis of kidney disease. I do not … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions, Laboratory Testing, Medication and Kidney Disease, Serum Creatinine

Dear Doctor, I apologize for the long mail. This question is regarding Hyperphosphatemia and suspected kidney troubles in my mother, 52 years old. She has a medical background of hypothyroidism. Two months ago, she was on Levothyroxine 25 mcg because of TSH reading of 11 uIU/mL. After two weeks of this medication, her TSH dropped to 0.19 uIU/mL, moving to hyperthyroidism, so she was advised to discontinue dosage. A lab test on November 4 revealed an extremely elevated TSH of 26.48 uIU/mL, and Creatinine reading of 1.03 mg/dL. BUN was 7.8 mg/dL, Urea was 16.9 mg/dL, but calculated eGFR was low, at 63 mL/min/1.73 sq.m. Following medical advice, we restarted thyroid medication at a lower dose, 12.5 mcg of Levothyroxine. She was also advised to drink sufficient water. After one week, on November 13, we did a detailed Renal Profile and thyroid profile. TSH was now lowered to 20, and the Renal readings were as follows: Cystatin C: 0.89 mg/L || CALCIUM 9.62 mg/dl (8.8-10.6) || URIC ACID 3.75 mg/dl (3.1-7.8) || BLOOD UREA NITROGEN (BUN) 7.45 mg/dl (7-25) || CREATININE – SERUM 0.64 mg/dl (0.5-0.8) || BUN / SR.CREATININE RATIO 11.64 (Ratio 9:1-23:1) || SODIUM 142.2 mmol/l (132-146) || POTASSIUM 4.75 mmol/l (3.5-5.5) || CHLORIDE 100.9 mmol/l (99-109) || eGFR: 103 mL/min/1.73 m^2. || Urinary Albumin to Creatinine ratio: 4.7 ug/mg of Creatinine. But, the phosphorous reading was at 9.9 mg/dL. Since this could indicate kidney problems, this has worried us, and we would highly appreciate your expert opinion. She does not have any noticeable symptoms and urination is healthy when she takes enough water. Her T3, T4 (Free as well as total) readings were always normal. Hypothyroidism is induced due to Autoimmune thyroiditis, as per tests. Thank you very much for your time.

I am unable to evaluate laboratory testing in this situation. The remarkable degree of laboratory variation that you describe is very concerning for the reliability of the laboratory. I am unable to provide a specific diagnosis based on the information … Continue reading

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

Trying to understand this x-ray result, can you explain please? Examination: KUB X-ray Clinical Data: Right renal angle tenderness x 9/7 Report: There is normal bowel gas pattern overlying both renal beds with patchy faecal mottling noted throughout the large bowel. No calcific focus is demonstrated over either renal soft tissue shadows or along the expected paths of either ureters.

This x-ray examination of the abdomen is normal except for some stool that is noted in the colon. No other abnormalities are noted.

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

Dear Dr, my 6 year old daughter has constant nose bleeds and swelling near the ankles. I took her to the Pediatrician and he sent for some lab work. Her BUN/CREAT ratio is 60. Is this high level common? He cannot see her until a few days. Thanks.

The Blood Urea Nitrogen to creatinine ratio (BUN/CREAT ratio) is not commonly used to estimate kidney function. An elevated ratio can suggest dehydration. An elevated BUN/CREAT ratio can also suggest that there is bleeding that is occurring and getting into … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions, Laboratory Testing, Pediatric Issues

Hello! My mother is 49 years old. 1 year ago her GFR measured 117, now the test came back with GFR 99. As it’s still above 90, should we worry? Her blood pressure is normal at 120/75, blood glucose is normal as well. Is it possible for GFR to fluctuate (she had stomach problems when the test was made, the general blood test came back with no abnormalities – no anemia). Thank you.

Both of these laboratory tests are normal. The normal estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per minute per 1.73 meters squared. The test results that you quote are within the normal variation for day to day … Continue reading

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

Hello, I’m 64 yrs old, had RA since age 27. Lots of other DX. Tinnitus & hearing loss getting worse & my hair is thinning real bad. Incontinence is a real problem this year. GYN Doctor has R/O prolapsed bladder. Some of my symptoms are : extreme fatigue, lot of pain, ( RA & fibromyalgia), back pain. The newest thing I’ve never had in my life is muscle leg pain: thigh & sometimes calf. I attributed these to my hip & back pain. I recently went to my primary care doctor and my rhematologist within 2 days of each other. On 10/8 the primary’s labs showed: Creatinine of 0.7, BUN/ CREATININE ratio of 27 (HIGH) (their normal says 10-20) , GFR 91.9 (their normal says 85 ml/min/1.73m^2) On 10/10, my rheumatologist’s labs showed: Creatinine 1.2 high (their normal says 0.6-1.0 ), eGFR 43 (LOW) their range is above 60. Medicine’s: I’ve been taking these drugs for years: Requip, Klonopin, Lexapro, Ranitidine, Folic Acid, Synthroid. Vitamin’s: D, E. I’ve been anemic for years, off & on ( 11.6 ) & had 2 episodes of black stool recently. Negative upper & lower endoscopies. On 10/10 my hemoglobin was higher than I remember ever at rheumatologist 13.2. Primary Doctor says the rheumatologist’s labs were wrong. I’ve been going to RA Dr. since 1988. I’m scheduled for repeat labs in 2 weeks at rheumatologist. MY 2 QUESTIONS: Do I need to go to a Kidney Doctor on my own? Can these 2 labs be so different within 48 hours of each other? Thanks so much.

I suspect laboratory error. The normal day to day laboratory variability is plus or minus 0.1 milligram per deciliter (mg/dl).  These two laboratory tests are not within usual laboratory variation. I suggest that you await a repeat laboratory test to … Continue reading

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

I had a urinalysis done in my pc’s office on 8/17/2018, results were acute cystitis without hematuria. Then my dermatologist sent me to quest diagnostics on 8/22/2018 for another urine test and feces culture. Quest said the feces culture (the next day) was NEG. for shiga toxins, eia w/rfl to E.coli 0157 culture, no campylobacter, or salmonella and shigella isolated. HOWEVER, they did say I had the e coli in my urine and that’s what caused my infection. I say if E. coli is in urine, it’s also in stool culture. I have 2 microscopes, 1 LED that you plug into your pc, and 1 regular light microscope. The test (dip stick) in the pc’s office read pos. for nitrates, protein 30, leukocytes >65 and gfr of 51, oh and they (pc’s office) forgot to call prescription in so 3 days later I received Bactrim, AND Cipro-which I asked for in the first place and the trainee (resident) told me no, to the Cipro, he was calling in the Bactrim. OMG I almost had a heart attack when I saw the gfr #. Should I be worried? No one else seemed to be. I am 61 and over the years I have had at least 5 kidney infections, including one hospitalization (I was pregnant) key here is a microscope is a microscope. I know when I did the stool culture, I looked at my stool and saw many worms, or larvae. I actually didn’t need the microscope. When I put the stool in the container (at home) I made sure to put the largest one on the top. I don’t know how they could have missed that one. Easily seen with the naked eye.

An E. Coli infection in the urine is not the same E. Coli that is being examined for in the stool. The enterotoxic E. Coli (also known as Enterhemorrhagic E. Coli or 0157:H7) is the bacteria being searched for in … Continue reading

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

I am Indian 63yrs old having weight 68.6kg.and height 5.5 ft. and have no other complications than serum creatinine 6.7mg% and Bun 63.4. My bp is 140/80. and no diabetic. Till to day I have no sign of any illness. On one occasion, when I went to native faced severe sun temp.at 47, and felt that my body became dry since then my appetite is affected and very recently on 22nd September on blood test my Hb found to be lowered at 8.9 and size of kidney became 7.20×4.5 RK and 7×4.2LK with above blood reports. Doctor diagnosed it may be a chronic renal failure[?]. I have no problem with urine, urine clearance and no pains any where in body but developed nausea for food. Is it sign of CKD or chronic renal failure? Difference between chronic disease and failure? Is there any way to make up Hgb at normal level? Does reduction in size of kidney reduces functional ability? If yes, what can be done to bring it at normal? Is Magnetic Biotherapies worth to undergo? Please advise me at the earliest to avoid any further complications in this matter. You may suggest any best place if treatment is to undertake.

Symptoms such as loss of appetite, nausea and progressive anemia with weakness are common with advanced kidney disease.  The anemia can be treated by use of Erythropoiesis Stimulating Agents (ESA’s).  The other symptoms may be more difficult to treat. I … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Treatments

I can’t get anyone in my dialysis unit to listen to me. I keep telling everyone that I don’t retain water. I still urinate at least as much as I drink, which is 8oz of coffee and about a 20 oz glass of water some days. I have asked other patients how they feel after dialysis and most say better. I feel awful, sometimes I want to eat everything but always I will sleep until the next day and could sleep more. My blood work always looks perfect, a liitle lie on calcium, protein and iron and if I make blood cells it is very few. (Before ESRD my blood sugar meter would many times say to use real blood and not work). My BS is in control. My doctor says do you think you are gaining weight and no I don’t. I am kinda stuck at 94 kilos. I believe they are dehydrating me to the point of tiredness or I am still too low on red blood cells.

I am not able to make a recommendation without performing a complete history and physical examination.  In my experience, most patients on in-center dialysis three times weekly, have symptoms of fatigue and need to rest or sleep for some time … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Treatments

Dear Sir, with many thanks for your kind website. Please be informed that I’ve have had kidney transplantation 16 years ago. The donor was my brother. ( my brother and I have one same father, but our mothers are different.) From 3.5 years, the creatinine has raised little by little. Now it’s 4.5 but BUN is 30. I have repeated blood analysis several times at different labs, and all the results were same. Honestly, my doctor is confused. She says that such creatinine must normally lead to higher BUN like 100 or more. Would you please let me know do you have idea in this regard?

The blood urea nitrogen (BUN) has many factors that can effect the value, so that a serum creatinine of 4.5 may not necessarily be associated with a markedly elevated BUN test.  For example, if you are a very muscular man, … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Transplantation, Treatments