Advice on GFR please

[Jlangley]

Hi there,

Just wrote and lost a long post, so this time round you’re getting the short version

Just back from doc where full panel of bloods was done (I’m hypothyroid and wanted to get full picture. GP is amazing and v supportive).

Below at results of full renal panel. Basically, she told me I don’t HAVE CKD, but I do have lower GFR/higher creatinine than she would like to see, and I’m on the watch list! She’s told me there’s no treatment for me as such, but to be “kidney kind”.

I have researched enough to know that there’s a strong link between compromised thyroid/kidneys. I’ve loads of stuff planned to help increase thyroid function, and I’m hoping that will have some impact on GFR (or at least limit further deterioration), but other than stay hydrated, eat a bit more protein and avoid certain meds, she didn’t really give me much to go on, and anything I’ve researched online so far seems to be aimed at people already with CKD, rather than those avoiding it.

Would love to hear some advice about positive steps I can take to reverse GFR trend (down to 65 from 68 last year) or at least halt decline.

Full results below if it helps...

Sodium 140 (range 133-146)

Potassium 4.4 (range 3.5-5.3)

Chloride 100 (range 95-108)

Urea 4.7 (range 2.5-7.8)

Creatinine 84 (range 45-84)

Estimated GFR 65 mL/min/1.73sq

Total protein 75 (range 60-80)

Calculated globulin 34 (range 25-40)

Albumin 41 (range 35-50)

Total bilirubin 6 (range 2.5-21)

If you’ve read this far, thank you!!!!

Any insights/advice very much appreciated!

[Cruze44]

I’m assuming your urine was tested for protein and blood right? Assuming those are normal and there’s no other signs of kidney damage then you do not have kidney disease. I’m exactly the same. eGFR of 65 but no other markers of disease. I just saw a kidney doc for the first time today and he told me I did not have any kidney disease what so ever and to stop worrying. This echoes the advice from my regular doctor and a doctor from the Cleveland Clinic I paid to assess my case online. They all three three said no worries, no diet restrictions, no nothing. They recommended that I get my labs done once a year and that’s that.

And remember, eGFR is more difficult to estimate in people with near normal eGFR (55-65). I read once that the confidence ratio in eGFR was over 90%. So that’s pretty good. BUT I’ve now come to find out that that means that 90% of people tested will be within 30% if their eGFR. And ever better news is that the tilt is typically tilted towards underestimating eGFR. So let’s just say my eGFR was underestimated by just 10%. Hat would put my real eGFR at about 72. And it could definitely even be higher then that. So I’d stop worrying if I was you. I’m gonna try to do the same!

And one more quick thing. You mentioned that you needed to consume more protein? Are sure you dont have that backwards? Typically a renal diet restricts protein. But that said, you do not have kidney disease so your doctor may have different dietary advice for you and you should follow it. All three of the docs I’ve spoken to told me I do not need to make any dietary change at all and to just use common sense. Stay active, try to avoid fast food, and go easy on the cola. Good luck! You’ll be fine.

[Jlangley in reply to Cruze44]

That’s great thanks for that! Yep I’m fairly certain she told me to eat more protein! I’m already doing that as part of a diet to reboot for thyroid / lepton resistance! She didn’t do urine as she wasn’t testing for kidney function specifically. She did it as part of a full blood panel to make sure there was nothing else thyroid related going on. Interestingly thyroid/kidney insufficiency (for want of a better term) are commonly linked due to t3 hormone production!

She did tell me I’m fine, and not to be overly concerned and that it’s more a case of just keeping tabs and taking precautions to avoid any drop in function and is going to test me again in 3 months. I’ll ask her to test urine next time for peace of mind but in the meantime I suppose I’m just curious to know if there’s anything else I can do to increase Gfr (other than going hyperthyroid!!!).

[Cruze44 in reply to Jlangley]

Well I hate to throw a little bit of doubt your way, but your doctor can't possibly rule out kidney disease without further testing. I had assumed you had a urine dipstick test done because it's the most common kidney function test there is. And it's basically free and results are immediately available. There are more precise and more expensive methods used to check urine for kidney function, but a simple dipstick test is pretty accurate and should always be done when ckd is suspected. Perhaps the office you was at just don't have them in stock or something. If not, you should have 100% been referred to office that does. Your eGFR is consistent with stage 2 kidney disease, just a few points away from stage 3. BUT, with no protein or blood in urine and no other signs of kidney damage this would be normal and nothing to worry about. So in short, i'd go and get that urine test. If there's no protein THEN you are perfectly fine and have nothing to worry about. You can also buy these test online and test yourself at home. They are less them 10 dollars for like 10 test strips.

Don't panic though! Even if you do have cdk, you are in the mild stage and will likely have many many years before it advances. If it ever does. Many people remain in stage 2 or 3 disease without advancing.

[Jlangley in reply to Cruze44]

Thanks Cruze! I’ll touch base with her this week about dropping in a sample!

[Celtic]

Like Cruze, I would question the advice to increase your protein intake. Although it sounds as though you do not have anything to be unduly concerned about (your blood results are all perfect), those patients who are usually advised to increase their protein intake are those on dialysis. Just have your kidney function monitored from time to time to ensure that it is remaining stable and you should be fine.

[lowraind]

I agree that you do need to have actual ckd testing done. I do not agree that you do not have ckd--you are in stage 2, which could easily go lower, if you are not careful. Also, go easy on sodium--we all consume too much sodium, unless we make a concerted effort to limit it. Since sodium, potassium, phosphorous and protein can all cause further problems down the road, I would get a 2nd opinion on the idea of increasing protein.

[motolas]

Your numbers are great! Continue with Dr advice and general knowledge of kidneys

[Jlangley in reply to motolas]

Thanks I know I don’t have too much to worry about yet. Just hope I can keep it that way! It’s a balancing act. Doc said be careful of salt for kidneys but not to cut it down as I have v low bp. I’ve to increase protein a bit for thyroid but not so much that i’ll be putting kidneys under pressure... im quite deficient in certain minerals which are more easily got from diet via meat/fish etc... it’s a bloody minefield!

[Jlangley]

Guys I rang my doc again to check in re the “increased protein” advice. She said that she doesn’t want me to go nuts on it but while I do appear to have slight issues with my kidneys, my thyroid condition is worse and needs more immediate attention and a higher intake of protein is recommended for hypothyroid diets. I used to be veggie (which she’s aware of), and don’t eat a lot of meat/fish (also aware of), so she feels on balance that increasing my protein intake (not madly), will do me more good than harm in terms of looking at where I’m at with thyroid/ckd. I’m to go back in three months for more tests and she said she wouldn’t expect a slightly higher intake of protein to have a massive effect on my kidneys between now and then. More likely, she said is that getting my thyroid back in good shape with meds/supplements/diet means I’m less likely to do damage to my kidneys longer term as their performances are linked via T3 hormone. Thanks for asking me to check in with her. What you were saying correlated with what I was seeing online, so I’m glad I got the clarity on this.

[WhollyAligned]

Hi there. Your labs all look great and I'm very glad to hear you have a supportive GP. And well done for exploring for yourself more the link between thyroid and kidneys. As a naturopathic nutritional therapist and yoga teacher as well as kidney patient, I take a holistic approach alongside latest unbiased scientific research. I would certainly suggest some gut healing and this is typically a great place for most people to begin. Anything that can help the systemic inflammation is likely to have a positive effect on your kidneys. So much stems from our gut health. I recommend The Gut Makeover by Jeannette Hyde. Excellently researched and advocated by the amazing Dr Rangan Chatterjee (who interestingly trained initially as a nephrologist). For the thyroid issue, a useful resource is thyroidpharmacist.com created by a pharmacist who struggled with thyroid issue and researched for herself tools to help. I also love the work of Dr Aviva Room for hormone issues. avivaromm.com

Epsom salts baths are always lovely. Source a bag either online or from your chemist. It's basically just pure magnesium sulphate. Kidneys, muscles and heart love magnesium. It's also an important nutrient for mood balancing and holding calcium safely into the bones. Add a couple fo drops of essential lavender or rose oil for added relaxation.

Finding tools to help you relax and tune into your own innate wisdom I cannot over-emphasise. For me I love yoga and meditation but explore what suits you. It could be as simple as sitting under a tree and imagining its roots and just noticing how you feel. Enjoy the exploration. Let it be a wonderful adventure to know yourself more fully.

[Jlangley in reply to WhollyAligned]

What a lovely response thank you so much for taking the time to say all that! I’ve actually started on apple cider vinegar and curcumin to try and get some healing going and have stopped all sugar/alcohol/gluten for min 3 months to give my body a break.. Between all the various supplements and meds I have to start taking I’m trying to just gradually introduce things so I don’t overload the system, but def want to get back into meditation etc. used to do fair bit of that! Thanks again for reply! X

[WhollyAligned]

You're so welcome. I absolutely salute and commend your efforts to eliminate sugar/alcohol/gluten. It's not easy but it's possible and getting the mind on board and really FEELING the benefits will help enormously. Curcumin is brilliant. Turmeric is such a wonderful herb and powerful reducer of inflammation. See how you go on the apple cider vinegar. In my clinical experience some find it a bit harsh and lemon in hot water might be better but if it suits you, no problem. Keep tuning in, don't put yourself under too much pressure. Truly you are doing wonderful things to help yourself. xx

[Jlangley in reply to WhollyAligned]

Thanks a million. Quite enjoying the ACV actually. Also using it now as skin/hair conditioner. Do love hot water and lemon too though, so using both (also as I struggle to make myself drink water but enjoy the flavors of these two a bit more!). What’s your take on magnesium citrate? Advise elsewhere was avoid it (because it can cause diarrhea), but I haven’t experienced any side effects. Would you advise a different form or reckon its ok? Thanks so much again!

[WhollyAligned]

Citrate form can indeed loosen the bowels with its laxative effect. Personally I use magnesium chloride in the form of Ancient Minerals that I apply topically. You can also get Mg Chloride in liquid form which avoids the body having to breakdown a tablet. Many supplements come with undesirable fillers and binders so it's something I am very discerning about. The Epsom salts baths are also a safe way and avoid the body having to assimilate through the digestive tract as the magnesium is absorbed transdermally based on the body's needs. Both are in what's called an ionic form that is more easily absorbed by the cells. As I am currently on peritoneal dialysis I do need to really tune into magnesium and be a bit careful but for you with your good kidney function, magnesium is absolutely fine. I would point you to the research of Dr Carolyn Dean as well who has spent years researching magnesium. drcarolyndean.com/magnesium...

You might also enjoy a flotation tank which is basically a giant magnesium bath.

[Jlangley in reply to WhollyAligned]

That sounds like an excuse to go for a spa treatment. On it!!! Lol Thanks so much for all this info. Really really helpful Hope you’re keeping in good health (I don’t know about peritoneal dialysis, but it doesn’t sound like nearly as much fun as a flotation tank! I hope its not too serious.)

Thanks again for your time, you’re very kind!

[WhollyAligned]

I'm so pleased it is helpful to you. That's the most important thing. Just a couple of points in your original post - sodium, as with all vital electrolytes the cells needs sodium to thrive. Generally speaking people eating high amounts of processed foods will be getting too much sodium and not enough potassium. This is a key ratio. For you with hypotension, salt status will be important and there could be a link between your thyroid issue and adrenals which need good levels of salts. So having a bit of pink Himalayan salt or a good quality sea salt is fine in your case alongside plentiful veggies for adequate potassium status. Taking a very low salt approach can lead to hyponatremia (low sodium) which is highly dangerous for the electrical activity of the heart as the sodium/potassium pump mechanism in the cells is what regulates heart beat. This is why it can be confusing for kidney patents being told 'low salt' in isolation of the full context of how the body works. Low salt absolutely does not mean no salt!! And as long as one is eating freshly prepared food with wholesome ingredients, high salt is less likely to be an issue.

Protein - generally in the west we over-consume protein and in poor forms such as commercially farmed meats that have been raised on grains and antibiotics. Certainly for animal products switch to grass fed. Cows are not meant to eat grains. They get infections in the stomach as a result and then this is medicated with antibiotics. All this goes into the food chain. A guide is for no more than 0.8 gms of protein per kg of body weight. Some people do well on less than that too. The urine test of course will be helpful here to ensure you are not leaking protein.

[WhollyAligned]

And thank you, I am keeping very well!

[Prayers]

Your doing good