Hello, I am a 34 yr old white, healthy woman, 5’6″, ~54-55kg. My eGFR is at 72-76, creatinine levels at 78-82. My urine was normal, and ultrasound showed normal kidneys, no family history of CKD. My kidney doctor said I can ignore my eGFR and that it’s low because I’m “skinny”. Would love to know if low/healthy body weight can affect your eGFR this much? Thanks!

Women have a lower estimated glomerular filtration rate (eGFR) than men and smaller people have a lower eGFR than larger people. Using our estimating equations, an eGFR greater than 60 is normal, hence your eGFR that you quote is within the normal range. Our estimating equations are not very good at telling the difference between an eGFR of 90 and 70. Hence, I agree with your physician.

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

Hi, do you have any website about having natural diet with kidney disease, especially juice treatment or herbal?? Thanks in advance.

I am not aware of any juice diet or herbal supplements that will benefit anyone with chronic kidney disease (CKD). In the early stages of CKD, Stages 1, 2, and 3, I am a strong advocate for the DASH diet. This diet has been shown to lower blood pressure, prevent formation of kidney stones, and may result in some weight loss. You should follow a low salt diet.  You can learn more about the DASH diet at: https://www.nhlbi.nih.gov/health/health-topics/topics/dash

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Herbal Supplements in Kidney Disease/Failure, Kidney-Related Health Questions

I have thin basement membrane disease. I found out in 2014. My GFR is 61. I have read most people with this disease have normal kidney funtion. What could be causing my kidney function to decrease? It took 14 years of blood in my urine to discover disease, that’s because of GFR 61%. Urologist told me in 2000. Some people have blood in their urine. My age 57. Thanks.

Thin basement membrane disease is typically not associated with any reduction in the estimated glomerular filtration rate (eGFR). The eGFR that you mention is 61 milliliters per minute per 1.73 meters squared. This would be in the range of Stage 2 chronic kidney disease (CKD) and suggests very early kidney disease. The blood that you describe in the urine (hematuria) qualifies you for CKD. I am unable to make any other kidney diagnosis based on the information that you present.

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

Test Report Beta-2 Microglobulin (ß2M) has been identified as the light chain of the HLA-A, -B, and -C major histocompatibility complex antigens, 100 amino acids in length and noncovalently associated with the heavy chain. ß2M occurs on the surface of nucleated cells- abundantly on lymphocytes and monocytes- and on many tumor cell lines. Its function is unknown, but it may control the expression and on the cell surface. Elevated serum concentrations in the presence of a normal glomerular filtration rate suggest increased ß2M production or release. What does this test report of myeloma panel mean? This is the report of patient suffering from chronic kidney disease.

Beta-2-microglobulin can be elevated in patients with chronic kidney disease (CKD) and is often elevated in patients with multiple myeloma. It be elevated in some patients with lymphoma and leukemias. For interpretation, you will have to consult with the physician who ordered the test in this particular patient.

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

I am a 60 year old Caucasian male, 180 lbs, who walks and attends gym regularly, non smoker, no alcohol but HIV+ virus non-detectable – on medication (triumeq tab for HIV+), atenolol (25mg) and Lipitor (10mg) all one per day. My eGFR has gone from 53 in May of 2015 with ups and downs to 42 in September of this year. Creatinine in the same period increased from 1.36 to 1.65. Kidney specialist has completed a battery of blood tests and urine analysis (including 24 hr.) No abnormal results arose from all of the tests and protein in urine is less than 6 mg/dl. Ultrasound shows one simple cyst but no other abnormalities. I have no physical symptoms. And no swollen lymph-nodes or swollen ankles etc., Kidney specialist says that kidney biopsy is the only option to give more information. Are there any other alternative tests that could be done? Many thanks!

A kidney biopsy would seem reasonable in your case. Most cases of kidney disease associated with HIV (+) status are associated with protein in the urine. You mention that your urinary protein is normal. It might be possible that your kidney disease is related to medication you are taking. It is not possible to do any other testing for kidney disease and a kidney biopsy would give you a definitive diagnosis. Hence, I agree with your nephrologist that a kidney biopsy is likely the best test to establish the cause of your kidney disease.

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

Can lactated Ringers be used in renal patients in an interventional radiology suite? Minimal amounts are administered per patient per procedure. Procedures lasting approximately 30 minutes – 1.5 hours.

In general, I avoid lactated Ringer’s solution in patient with advanced kidney disease because it contains potassium. The amount of potassium is relatively small, but even small amounts of potassium in some patients can be associated with a rise in serum potassium that may present a problem for someone with advanced kidney disease.

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

Sir, we are going for kidney transplant and want to know what are the test to be done of donor and recipient and how much the results have to be to match? Please send me reply. I shall be very pleased. Thank you.

The testing required for a kidney transplant varies with the transplant center, but in general requires ABO blood type matching, HLA-A, HLA-B and HLA-D testing, as well as cross-matching. In some laboratories, Anti-HLA testing and Panel Reactive Antibody (PRA) testing is done. All of these are very complex tests and require analysis by the transplant surgeon and the transplant nephrologist as well as the immunologist. The donor must also undergo testing to make sure that he or she is safe to undergo anesthesia and healthy enough to permit a kidney donation. The recipient must be accepted on to the transplant list before any of the above testing is done. This process varies by transplant center but usually involves medical consultation, evaluation for heart disease and examination by the surgical and medical staff prior to being placed on the transplant waiting list.

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

Hi sir. I want you to know that I have one kidney from my childhood. I did my blood test a week ago and found that my overall result was fine but my GFR was 43 and my creatinine level was 1.5mg/dl. Now tell me is there any risk?? or it is normal and also guide me with a diet plan to reduce my creatinine level. Thank you so much.

You mention that you have a single kidney. It is unclear if this was from birth or you lost one of your kidneys in childhood. I am unable to make a specific diagnosis based on the information that you present. Your estimated glomerular filtration rate (eGFR) is low and it would be low for having a single kidney. There is no diet that will lower the serum creatinine. The goal of diet is to make the kidney function for as long as it can and as well as it can. I am a strong proponent of the DASH diet with low sodium. You can review the DASH diet at: https://www.nhlbi.nih.gov/health/resources/heart/hbp-dash-introduction-html

Posted in Ask the Doctor, Diet/Nutrition, GFR, Kidney-Related Health Questions, Nephrectomy / One kidney, Serum Creatinine

Dr. Spry, My father suffered a kidney failure, apparently resulting from a UTI this past March. Though he is a long-term diabetic (over 27 years), his medical records state his condition as AKI rather than CKD. He is now dialysis-dependent, but his doctor seems to believe his kidneys could recover sufficient functionality for him to go off dialysis, though it’s been nearly 8 months since the diagnosis. What indicators would a doctor use to identify AKI vs CKD in a less obvious scenario where the UTI or the Diabetes could be the root cause, unlike an actual physical injury or nephropathy in the absence of a pathogen beyond diabetes, where I presume it would be easier to classify as AKI or CKD, respectively. How would the doctor determine if there is a possibility for some kidney function to return? From what I can tell of his creatinine, potassium, urea, albumin levels, there doesn’t appear to be a consistent improvement in any metric that would allow a quantitative assessment of kidney recovery. Is there a qualitative method to assess the viability of a kidney? Short of a biopsy is there another quantitative method outside the typical blood work to judge how much kidney function is just dormant vs. how much has been lost permanently? Apologies for the multiple questions! My father is being treated at the top hospital in his city, one well-known for international medical tourism (though he’s a local). His doctor appears to be a very competent and straightforward professional. Unfortunately, doctors in India are extremely reluctant to share technical patient information and I’m relegated to scouring the internet to help my dad navigate his condition. Thank you for any information you can share on the subject!

Acute kidney injury (AKI) means that the tubules of the kidney have been injured but the filters of the kidney (glomeruli) remain intact. If there is tubular injury, then the kidney is capable of repairing this injury and then the filters start working again. As the filters recover, the kidney function gradually returns. If this is chronic kidney disease (CKD), then the glomeruli of the kidneys have been damaged and this cannot be repaired. Once you lose glomeruli, then they cannot be repaired or replaced at the present time. In some cases there was pre-existing CKD and then AKI was superimposed on top of the CKD. In this case, both problems are present and recovery of kidney function becomes less likely. In most cases, if AKI is going to resolve, it will resolve in 2-4 months. If your father is still on dialysis at 8 months, this is a very poor prognostic sign. The only way to tell for sure is to perform a kidney biopsy and see what the underlying disease may be.

Posted in Acute Kidney Injury, Ask the Doctor, Chronic Kidney Disease, Diabetes, Dialysis, Kidney Failure, Kidney-Related Health Questions, Urinary Tract Infection/Pyelonephritis

Hello, I recently got my ultrasound results and everything is normal except for IMPRESSION: Negative Renal Sonogram. I’m just curious of what it is?

A negative renal sonogram is the same as a normal ultrasound examination of the kidneys. It means the same thing.

Posted in Ask the Doctor, Kidney-Related Health Questions