Referral to renal unit?

[4wXcF]

I’ve recently been in hospital for angioplasty which unfortunately couldn’t go ahead due to the twisting and an aneurysm in the RCA.

I had a kidney removed 3 years ago due to cancer and the remaining kidney never picked up from about 45 gfr. It has gone steadily down to 37gfr. I had blood tests carried out during my stayin hospital and at one point gfr was 25. It was 30 gfr last Friday. My GP carried out blood test on Monday and I had a phone message to have another one in a months time. They are always reluctant to tell me the gfr figure.

Would it be appropriate to ask for referral to local renal unit?

[Darlenia]

Yes! That would be a wise thing to do. I'm surprised, actually, that there isn't a nephrologist in the picture already. If you like your primary doctor, ask him for a referral. Most primaries are happy to assemble a supportive team around you and arrange for sharing of information. It's good to be proactive.

[4wXcF in reply to Darlenia]

Thank you

[RickHow]

We are very close to "twins". I had a kidney removed due to cancer in mid 2017. Due to age (I am 71) as you said in your post my remaining kidney started immediately at 38. Settled in about 40. Since then it has reached as high as 53 (one time) and as of today is 40. My kidney cancer came back into bones within my body 1 year after kidney removal. Since then I get cancer treatments every 3 weeks and my blood tested each time. For a while I hit 46 for 2 or 3 months, but lately it has stayed at 40. I DO see a kidney doctor every 6 months. She does blood but more importantly urine testing to be sure no protein leakage, etc. She advises me that while egfr is a good guide the more important and easier thing to watch is Creatinine levels. Most blood testing will have a "normal" range as high as 1.2, or some labs say 1.5. BUT as she advises me, the true NORMAL for a person with one kidney, such as ourselves who has in our adult life had a kidney removed, is generally 1.8 or 1.9. This will of course give you a lower egfr than what is considered good, but if your Creatinine stays between 1.8 or 1.9 you are doing fine. Of course there are individuals (younger) that when a kidney is removed the other kidney maintains a "normal" result, but for most it is 1.8 or 1.9.Now as you can see my egfr fluctuates too but not as significantly as yours.

You feel you want to see a kidney doctor then absolutely satisfy yourself and ask for referral. Personally I have found my kidney doctor has provided nothing much compared to my normal GP and oncologist. EXCEPT she does check for protein leakage in urine, etc. But unfortunately all she can really do is provide general dietary guidance. There is no magic wand nor pill that can make our egfr go back to "normal". BUT another thing you should consider (demand) is some type of scan or ultrasound of your kidney and urinary tract. It can be there is some other thing going on besides a declining kidney (such a stone, or uti, or blockage, or tumor on the kidney, Don't be shy with your doctors. Ask whatever is on your mind no matter how silly you think it might be. Remember doctors are just people (educated) and not always perfect, speak up for yourself respectfully. Ask for a kidney doctor and it will be one less thing on your mind. Keep us informed.

[Darlenia in reply to RickHow]

Your advice is always so good! Interestingly, my hubby (with the kidney issues) and you are the same age. May your path to wellness be smooth and gentle.

[4wXcF in reply to RickHow]

Thank you for replying to my post which was very helpful. I saw my GP this morning and learned the egfr last week was 29. He is arranging another blood test in two weeks with a view to referring me to renal unit if not much improvement. I see from the blood test taken in hospital the creatinine level is “157” which is a different type of measurement from that you mentioned

[RickHow]

In the USA Creatinine is generally measured in units of mg/dl. When I wrote for example that is it NOT unusual for a person with one kidney to have a Creatinine measurement of 1.8 or 1.9 those are measures of mg/dl. You apparently live in a country that measures in units called umol/L. If you convert your result of 157 umol/L to mg/dl you are very close to, but not quite at 1.8 mg/L While this will conclude that you are at "stage 3 ckd" (if you had ckd) that is MODERATE reduction in kidney function. BUT as I previously said, I too am with one kidney and have been in the exact same range as you (1.7 to 1.8) which my doctors say is NOT unusual for a person with one kidney that did not pick up as you yourself said. The current way they calculate EGFR DOES NOT take into account if a person has one kidney or two but is based upon the "normal" person with two. While we (people with one kidney at 1.8 or 1.9) should follow the typical practices of a person with actual CKD (don't eat too much protein, keep hydrated, etc.) it is no reason to believe with have "typical" ckd. Here is a quote, which is on many reliable websites:A person with only one kidney may have a normal level of about 1.8 or 1.9.

Here is a link to one such website: (within it mentions 1.8 or 1.9 for one kidney can be normal).

medicinenet.com/creatinine_...

If you are deeply interested I recommend you go to google and search on the following, and will find MANY websites about solitary kidney and how 1.8 and 1.9 is NOT unusual. Search for:

what is typical creatinine level for someone with solitary kidney

[4wXcF in reply to RickHow]

Thank you for that information. It is very interesting and I’ll do some more research