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Early CKD Support
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Should I see a nephrologist?

Hi all,I'm a newby here. I've been reading for a couple of weeks but have a questio since my last round of labs. I have not be formally dxed with CKD but it looks like it may be a problem from the numbers. I had blood work 3 times each 6 weeks apart. GFR 43-39-51. BUN 32-32-24. Creatinine 1,28-1.37-1.10. K+5.0-4.4-4.8. Also have had microscopic hematuria with almost every urine dip and urine protien of 30 twice. My GP says I'm anemic and seems more concerned with that. Had a CT of my kidneys and it showed a"soft tissue density" in my left kidney which lead to a retrograde pylogram and cytology washing which was negative. My Dr's last statement about my latest GFR was "well it's a little better." Would you see a nephrologist? I recently read that they would rather see you with a GFR of 60 than wait for it to hit 35. Thanks Debi

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I guess just depends on when you get a referral to Nephrologist, as on Medicare they would rather you see a Nephrologist at CKD level 4, than level 3.

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Medicare has no restrictions on seeing specialists, nor do you need a referral to see one.

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Thanks will check into it. At one time there were restrictions on Nephrologist referrals.

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On traditional Medicare? Medicare Advantage has restrictions on a lot of things. But traditional Medicare is pretty open to most everything.

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I was referred at stage 3 and have had not problem with Medicare.

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I would insist on seeing a nephrologist. There is always criteria that your GP must do before they refer. Sounds like you have been through 3 sets of tests. Something is going on with your kidneys and you need a specialist.

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Agreed!

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hi, I would make an apt., but until then look up Danita and the kidney diet, watch sodium, potassium, some say magnesium too. Pain killers, steroids, stomach meds, high blood pressure can be rough on kidneys. Drink plenty of water and avoid drinking soda if you can. There is also a test called a renal scan that can show exactly how kidneys are working.

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DaVita is a “for-profit” medical provider. While they put up a lot of info on the web - how much of it is to attract business?

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it is a way to find proper diet

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Well I guess I am going to be the odd guy here and say don't bother. Here is why. I developed kidney cancer in one kidney (found by a CT scan for a different medical problem). I was sent to a urologist. The kidney removed. Before removal all my "numbers" were well within normal ranges. Immediately after removal my egfr was 35 (not 40 or 410. I was ckd stage 3b. I continued to see my gp, and my urologist, an oncologist, and was even referred to a cardiologist (since most people with CKD actually develop and die from cardio problems, not the kidney). But not a kidney doctor. I asked why. They all said the same thing. It would just be a waste of time since my gp and urologist were doing all the appropriate blood and urine tests and dietary advice. And my oncologist was testing chest and liver routinely to see if any cancer is spreading. Finally after my repeatedly asking, I went to a kidney doctor. They were right. It was useless. What did she offer? Another blood and urine test every 4 months. Watch your salt, control your blood pressure, blah, blah, blah. All the things I could have told her anyway. If it gives you peace of mind, then go to one. It is harmless to try. But if you have a good gp in place and are being tested regularly, be confident.

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a solitary kidney will show lower numbers

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Yes. This is one of the problems with the egfr. It does not take into consideration circumstances of the patient. It just says "this is normal" based upon our studies. But the results are for a person of a certain age, race, sex and with two kidneys. It does not take into consideration what is "normal" for a person with one kidney. As you say, if you have a solitary kidney it is not unusual to have a higher creatinine level, which will yield a lower egfr. The lower egfr will be classified for example as say stage 3. When in fact your existing kidney is not diseased, is not even failing, but simply can not do the work of two. Yes people with a solitary kidney can have "normal" numbers too. It all depends on the person. for some, especially younger, the remaining kidney internally "grows" and handles most of the workload. In those over 60 or 65 this is not likely. This is why my doctors all say ignore egfr. The best way to judge your "health" is to monitor creatinine and bun/creatinine ratio. If your ratio remains good, then most generally you remaining kidney is functioning find. For creatinine it is not unusual for the level to be 1.7 or 1.8. If it remains fairly constant over time, then your remaining kidney is doing its job.

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My GP and Urologist are monitoring the CKD also and do the follow up tests. Might just stick with what I have. A good GP and good urologist who has experience with CKD.

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Thank you all for your kind advice. As an RN I thought maybe I was being a little overly concerned. My GP didn't seem as concerned as I am but you all have validated what I am thinking-it might be a good idea.

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Your BUN numbers show you are a little dehydrated and so that affects your creatinine. Your creatinine is the high side of normal which could be the result of dehydration. Your eGFR can be affected by that also

If you have a good primary doctor who continues to do urine and blood tests you do not need to see a nephrologist. He would do the same thing. Usually, in my case anyway, I did not start seeing a nephrologist till my creatinine was a steady 1.5.

I am now 19 years post transplant and am doing great!

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I am a hard stick and had to go back for a second time for the 2nd set of numbers. I did hydrate well before the the 2nd and 3rd sticks as the failed 2nd stick, she stuck me 5 times. I let her hoping not to have to come back.

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Hi debi, may I ask how old you are? It is part of all of this. Thx.

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I turned 60 this year.

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Hi I would think the next step would definitely be a nephrologist referral.I would talk to your GP about this if he has not already made one.

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hi..sounds like a specialist would be good for you because you dont seem to have confidence with doc or figures..ask to be referred... cant fefuse ..and take it from there...a good tip avoid pain killers not good for kidneys...check on line...regards chris who has been there and not acted...

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I have an appt this week! GP made the referral. I take 1 aleve a day as far as NSAIDs and a tramadol, also 1 a day. Have DDD and osteoarthritis, so it's rough without anything and I don't think that amt should hurt my kidneys.

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I saw a nephrologist. He thinks that I might have IgA nephropathy. He did some more blood work and a urine sample. I go back the beginning of the year for a repeat of blood work. So far no changes except he told me to stop NSAIDS 72 hrs prior to labs. so we will see.

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