Rapid decline in gfr

[itzmich]

The last month has been challenging. At the start my gfr was 56 one week later 41 now 35. All my other numbers in the normal range. Had my ultrasound and it show no blockages or anything abnormal. Good report. BP is low due to medications. No symptoms other than fatigue. Eating a good diet, losing weight swimming 4 times a week. Is it possible in a months time to go from stage 2 to 3b so fast. Still have not gotten an appoint to the nephrologist hsve had my doctor personally reach out to get me in. She is baffled. I am scared at this rate in a months time I will need dialysis. Has this happened to anyone what is going on. I actually feel good. Just worried sick. Any suggestion?

[Julesboz]

Hi there, kidney function can fluctuate for various different reasons. I have stage 3 CKD and have fluctuated between GFR of 60 and 49 over the last 10 years. I’m currently at 59, so just because it goes down it doesn’t mean it will continue (I dropped from 60 to 49 in a month period). I have no known medical reason for my CKD, but I’ve discovered that my dairy intolerance tends to upset my kidneys. All scans and other tests have come back fine. You say you’re on BP medication. Does the medication you take cause a temporary drop in kidney function? Could you have been dehydrated? Are you eating a lot of red meat or salt? All sorts of things can cause a temporary drop. Continue to ask your doctor questions and hopefully a nephrologist will help.

[itzmich in reply to Julesboz]

No salt no meat staying hydrated took my 1 BP in the morning it was 2 PM when I took the test. Been getting the test once a week.....down, down down not few point either. At this rate in less than a month I'll be in kidney falure

[itzmich in reply to itzmich]

Also in one MONTH 59-56-41-35. I get it taken every Week.

[Julesboz in reply to itzmich]

Try not to worry, like I said, just because it’s going down now it doesn’t mean it’ll keep going down. Your doctor will be investigating. Mine did the same several years ago and went back up again. The nephrologist at the time (before I knew I had CKD) told me that these things just happen sometimes. Ask your doctor lots of questions and try and expedite the nephrologist appt.

[itzmich in reply to Julesboz]

Thx I am

[Margie5967 in reply to itzmich]

I test quarterly.

Are you testing at a Dr’s office weekly?

I wish there was a way to test at home, like people who have diabetes.

[itzmich in reply to Margie5967]

Yes I am.

[Sally10255 in reply to itzmich]

hi, There is a test called a renal scan that will tell si much about kidney function. I suggest you ask about that. I am not convinced ultra sounds pick up everything. I had an ultrasound, showed kidney not draining. I felt a great deal of pressure down low. I asked about possible stone. They said they didn't see any stones. 2 days later I was in agonizing pain. A 6 mm stone had dropped down. Doctor scheduled same day surveying after verifying with CAT scan. Ends up I passed the stone, never knew it. Doc went in to get stone but it was gone. But, he saw my left kidney is badly damaged. He thinks the stone had been in there a long time wreaking havoc. I look back and remember brown urine and lower pelvic spasms. He put in a stent that helped. The stent has been removed. Things stsying status quo. Also creatinine numbers got a tad better. No painkillers, no extra proteins, vitamins, salt, etc. Great luck!!

[itzmich in reply to Sally10255]

Thank you💕

[Celtic]

Izmich, you say “BP is low due to medications”. What are those medications? Some are known to drastically reduce kidney function and, if that is the case, the medication has to be stopped/changed.

[itzmich in reply to Celtic]

My doctor checked both BP meds and said they're fine

[Julesboz in reply to itzmich]

‘Fine’ is a matter of opinion. My GP told me it’s ‘fine’ to take naproxen/ibuprofen but most nephrologists will tell you to steer clear of them as they’re bad for the kidneys. I therefore never take NSAIDs. I would investigate that further.

[itzmich in reply to Julesboz]

I will ........never take pain relievers. Appreciate your reply

[itzmich in reply to Julesboz]

Taking Losartan 25mg 1&1/2 tablets in morning and amlodipine 5mg at night. Some articles say they are fine and some say causes kidney damage....confused

[Julesboz in reply to itzmich]

I’m afraid I don’t know anything about BP medication, but hopefully someone a bit more knowledgeable will reply about them.

[itzmich in reply to Julesboz]

Thx

[Celtic in reply to itzmich]

I would suggest stop the amlodipine and see if there is an improvement. My solitary kidney is stable on 50mg Losartan Potassium. Amlodipine caused me all sorts of problems.

[cornflake57]

There are five stages to chronic kidney disease with sub categories in between. It’s quite rare to move to stages four and five, most people stay constant at the stage they are in for years. Your GP won’t refer you to the renal team until you reach stage four or have a family history of renal disease. It is more likely that your raised blood pressure is causing the damage to your kidneys.

[itzmich]

Thx.....my mother had kidney failure and my sister has stage3b.

[lowraind]

Drugs.com | Prescription Drug Information, Interactions & Side Effects

This site might give you the information you are looking for.

[itzmich in reply to lowraind]

Thanks

[RickHow]

I'm at stage 3b. Certainly each person is different but what you report would alarm me too. What really, really surprises me is the delay to be able to see a kidney doctor. I see 5 different doctors (kidney, heart, cancer, gp, urologist). to get an appointment all I have to do with any is pick up the phone, ask for an appointment. The only doctor which usually takes longer than a week to see is the urologist as in our area there is are only two. I have had occasion where there were longer delays. On two of those occasions my concerns were like yours where something dramatic was happening (not kidney related) and rather than wait I went to the emergency room. I simply can not imagine having my gp see such a dramatic drop in egfr as you are having and simply say to me, see your kidney doctor. It seems yours has given you scans and tests (which I assume eliminated such basic things as kidney infection, urinary tract blockage, kidney stone, tumor). someone else mentioned amlodipine. I too had experience with amlodipine and lisinopril (I was taking both daily) which reduced my eGFR. Both have been found to have a negative effect on people with CKD. They become necessary drugs, and are even used to treat some people (lisinopril) when protein is found in the urine. But in some stages of CKD they hurt, not help. My dosage of amlodipine was reduced from 5mg TWICE a day, to 2.5mg once a day. My blood pressure actually went lower without the blood pressure medication and my eGFR went up 5 points. I am currently under an "experiment" my heart and gp think will be beneficial to me with lisinopril reduction. I was taking 10mg twice a day. They are reducing that to 10 mg ONCE a day. We are trying this for 6 weeks and then will measure kidney functions. Again, my blood pressure (which I take 2 times a day at home) has actually gone down (slightly, about 5 points each) by taking less medication. Hopefully this is what you will find, that your medication (particularly amlodipine) is having a negative effect and another drug (not a CCB such as amlodipine) is the problem. Oh, last year I was also trying losartan. This was stopped after just 6 weeks as it was having a very negative effect on my results. Now this may not be the case for you. Each of us is different. But I see others have written you with similar changes due to medication.

[Celtic in reply to RickHow]

Rick. I’m intrigued about your mention of Losartan having “a negative effect on your results”. Would you mind telling me in what way? For instance, did it show an increase in your creatinine level? Losartan certainly increased my creatinine within a short time of starting it but my renal consultant said they expected that but it didn’t mean that it was impacting on the kidney function per se.

[RickHow in reply to Celtic]

Hi. first about me to help you "compare". I am 68, stage 3b. Had 1 kidney removed in July 17 due to a cancer tumor. It was in center of kidney so partial remove was not possible. Immediately my egfr went from "normal" (over 60) to 35. Typically the other kidney will increase function and pick up some of the "workload" the other kidney performed, but usually not 100%. In my case the remaining kidney picked up some and went to what is my now normal efgr range of 38 to 41. There it stays. My creatinine level started to go from 1.9 (post removal) down to 1.7. But my bp went up so losartan was tried since the lisinopril did not seem to be working. My creatinine went up promptly to 2.0. So my gp thought what is the point in continuing with the drug when there are so many alternatives. So we abandoned the ARB approach and tried just a CCB (amlodipine). 5mg twice a day. Did okay controlling the pressure during the day but when I would wake in the morning the pressure was sometimes 160's. BUT by stopping the losartan my creatinine went down to 1.7 where it has fairly constantly remains. All my doctors say that while there certainly are people with just one kidney that have "normal" egfr's, it is more usual to have creatinine levels of 1.7 to 1.8 and thus be classified stage 3. But this is not really stage 3 caused by kidney failure as much as it is stage 3 because of just one kidney and not "really" CKD in the typical sense. So we added lisinopril 10mg twice a day. The pressure came down. But in this time I reduced my protein intake to less than or equal to the daily recommended requirements and the same for salt. Well the pounds just dropped. I lost 30 pounds! Not really a diet. Just watching protein. With this my bp dropped dramatically too. And we have been reducing the bp meds and now are even lowering further as I explained in a previous post, with my lisinopril. The med reductions have improved my egfr so it now remains in low 4x range. My creatinine is down to 1.65 to 1.7 consistently. So yes, losartan RAISED my creatinine levels, and reducing lisinopril and amlodipine have lowered my creatinine levels. Not dramatically, but definitely. Primarily reducing the drugs stopped what was the constant gradual rise in my creatinine..

[Celtic in reply to RickHow]

Rick, please see my above reply - sorry sent it to myself!🙄

[Celtic in reply to Celtic]

Thank you. Rick. Wow! You are doing well, and that’s from another sole kidney survivor! You’ve probably already read my story in a reply to others. I, too, have just reduced protein levels, lost about 10 lbs in weight and had a bit of a boost in my kidney function up to eGFR 43 with an improved creatinine reading of 107. Sorry, don’t know where you are but I don’t recognise your creatinine readings as we calculate them differently here in the UK. I’m 76 and also CKD3b - my sole kidney has served me well for 64 of those 76 years with all normal readings until about 12 years ago when an undiagnosed inflammatory illness together with the NSAID, Ibuprofen, and the contrast used in scans got in the way! I have to live with Losartan as my body can’t tolerate other BP meds. Not controlling my BP well but have to live with it and cross fingers. Maybe yet more weight loss may help although I am just within the normal BMI for my height. May you long continue to do well.

[RickHow in reply to Celtic]

I am in New York. I'm not sure that I am doing well or not. :). With every test I get the egfr between upper 30's to low 40's. All because of creatinine in the 1.7 to 1.8 range. that is mg/dl.

[Celtic in reply to RickHow]

Rick, I would definitely say that you are doing well. I have a friend who lost a kidney to a tumour 3 years ago at the age of 78 and her kidney function is now stable in the mid 30’s. She continues to have scans to check that all remains well with the solitary kidney but these have now been reduced to just once a year. She looks and feels amazing. I will try and research the UK equivalent to your mg/dl readings.

[RickHow in reply to Celtic]

Thanks for telling of your friend. It encourages me greatly to have hope. My scans and tests have been every 6 months. They tell me if stays stable they will move to once a year, after the next tests. My gp does blood work every 6 months. Always has done this for years.

[itzmich in reply to RickHow]

Thanks very informative. Here you need a referral before going to a nephrologist. I have a referral but they review to see if its necessary. Apparently that can take weeks or months. I am willing to travel to see one still waiting. 24pts in a Month seem odd to me all my other functions normal. Ultra sound normal. Doesn't sound normal to me!!!!

[RickHow in reply to itzmich]

Here (New York) we too need referral for our first appointment with a kidney doctor. But that is just a formality that the gp sends the referral on line and the appointment is made. Should not be that you need to wait. That is so unfair to the patient. You should know that on all my tests and labs also, everything single thing is normal, except my egfr is upper 30's to low 40's.

[Gmagolf]

It’s scary. Are you on antibiotics or any meds? I had mine drop drastically while on antibiotics and it came back up when I stopped antibiotics. Have you been tested for autoimmune disease that could be attacking your kidney?

[itzmich]

No antibiotics. I've thought of that I'll bring that up at my next appointment. Thank you this community has helped.

[Celtic]

itzmich, now that you have mentioned your Mother and sister’s problems with their kidneys, it does sound as though there may be something genetic going on. Whether that may point to some familial autoimmune condition as Gmagolf has intimated, who knows. Certainly there are such autoimmune conditions, including Lupus, and even vascular conditions, that can attack the kidneys but I would have thought that you would be experiencing certain other symptoms. Having said that, there are a multitude of autoimmune inflammatory conditions and some of them can be very very difficult to diagnose.

[Alex6157]

Hello, itzmich.

I have experienced very significant eGFR fluctuations in either direction: from the baseline eGFR of 56 four years ago to 65 within a month of starting dieting, later it even hit 73, after several months from then it dropped down to 50, then went up and stayed at around 60; now it is 55. Your eGFR drop does not necessarily mean actual decline in kidney function (at least, not of that magnitude), chances are the picture can improve just as unexpectedly and unexplainably. Keep monitoring.