A poster posted some blood results about a year ago, along with range applicable.
Serum creatinine 89umol/l (45 - 90)
Serum urea 7.7 mmol/l (2.5 - 7.8)
Serum sodium 137mmol/l (133 - 146)
Serum potassium 4.7mmol/l (3.5 - 5.3)
GFR 62ml/min
All the results are 'in range'.
He was advised that there were signs his kidneys were under duress and to take action, like backing off protein consumption or not lifting weights (if he lifted weights). The sign was some measurements being close to the top of theirrangee. Someone said he should aim to be mid-range.
Is that the case? Is it that for everyone, mid range is the right place to aim for and drifting to edge of range is indicative of something going wrong.
I would have thought one person's healthy kidneys would produce a result at x part of the range and anothers a result in y part of the range.
I wouldn have thought (but I could be dead wrong) that the range was some statistical thing. That z proportion (a statistically substantial proportion) of the healthy-kidney-population gave this range of results. Once you were inside the range you were ticketty-boo (a.k.a. in the clear).
Not so??
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Skeptix
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HI Sleptix, I think the major thing wrong with this information is there is no age present. If this person was in their 20's, I would be very concerned with a 62 GFR and the high end of the other numbers, even though they are in range. If the person was 70.... I would say that they were ticketty-boo. ( I love that)
Good point on age. But why on being near top of range? Is it not that a healthy kidney could filter and produce that result. Or is it that every healthy kidney ought to be smack middle of range?
I'm interested because my new renal dietician said I should cut back a little on high potassium food. Even though I'm in range. She's gone on hols so I can't asl why.
Each laboratory based on its protocols has a different range. Some things may be the same from lab to lab but not all. For instance, one of the labs from one doctor lists the upper range for Potassium as 5.4, another on lists the upper number at 5.3. However, my nephrologist has the number at 5.0 which is where many of the USA kidney organizations place the upper end, especially if you are CKD and have hypertension.
Thanks. That's another area for investigation - where ought you be for eachetric? Lee Hull dug up the science indicating it best to be at the higher end of the normal BMI. Makes sense: a bit a fat on you is a good thing given a CKD er is more likely to end up in hospital.
But whatever the range used, my question is: why would being at the higher (or lower) end of it be a sign of something amiss? How is 'in the middle of the range' considered optimal when surely different healthy kidneys produce different results?
I'm not interested in any discussion of Mr. Hull and his theories. I answered why the numbers are different from lab to lab. Put together a Care Team you trust, do your research based on your personal health history, and follow your doctors advice/suggestions, and recommendations.
Fair enough on Lee Hull - it was merely illuminating the question.
The question was: is it the case that a serum reading (e.g. creatinine, urea, albumin) ought to be middle of the range* . If so, why so? (for it would imply that every healthy body ought to produce the exact same serum level of creatinine, urea, albumin, etc).
I would have thought a healthy population would produce a range of results. And that once you were in range you could be considered in the healthy zone for that metric.
On that basis let me explain. I chart on a spreadsheet all of my lab results. If the number starts out in the middle of the range, okay. But with the next lab I notice it is creeping up toward the upper end, I can watch for the next lab or two and determine if it was an anomaly or a definite trend. I can then ask my doctor or dietitian (depends of the specific test) what can I do to hold it steady. Potassium, as it creeps up I can adjust my meal plan and lower my Potassium food intake. All of the physicians on my Care Team are aware of this and know that I try to stay on top of my lab results. On the flip side there is nothing you can do for some specific test(s) that are always slightly above the top end and this is do to having a chronic illness and knowing that my kidneys, for example are not functioning at their optimum level.
Physicians have hundreds of patients, but I only have to worry about, ME!
Gotcha. Although we're slightly at odds with each other.
What you've got going is a situation where your kidneys can't keep stuff in spec by themselves. Let's say it's potassium. And so you dial your diet up or down to do the job your kidneys can't do anymore. A reading at the high (or low) end of the range is effectively saying "you ain't steering the ship" and you correct course to suit. Right?
What I'm talking about is slightly different. Take me for instance. My potassium readings have never been out of spec. I've eaten what I want for the last 7 years of having CKD and that potassium has always been in spec.
Let's say my last blood shows my potassium reading to be well on the higher side of mid range.
Ought I start reducing my potassium intake?
Or is it the case that my kidneys are still controlling within the normal range that kidneys control potassium. The data says they are still doing the job so there is no need to intervene.
That was my original question: should we expect our kidneys to hit centre range. Or it is normal (even for damaged kidneys) to fluctuate around mid range AND there being nothing amiss with their being above mid-range, per se.
Please refrain from super analyzing everything to death. If you can't find a physician who you trust, move. If that isn't possible go to med school. People who have CKD need to become informed and then take charge of their health. You have a choice. You can either accept their information and advice or move on and deal with your own situation.I'm not going to tell you how to handle your specific health situations. Your kidneys are your problem. My kidneys are my problem. The community guidelines are meant to inform, advise, and support you on this journey. If you feel you can get what you need from a book, or a supplement, then go for it, and if that works for you, terrific.
You have questions that are beyond the scope of what we do here. Find the answers in the members of your own Care Team. I wish you well on your journey.
Asking whether (when you've never been out of range):
- it's okay to be anywhere in the range
or
- whether deviation from middle of range tells you that something could be up
.. is hardly an overly-analytical question. It's about understanding what being in range actually means. That's very basic stuff.
Given a dearth of nephrologists in my country (and an absolute scarcity of renal dieticians - that I've obtained one is utterly one-off territory), your advice to "move" isn't quite as easy to implement as you would suppose. Indeed, figuring out how to trust a doctor is the question demanding an answer.
You clearly have a bee in your bonnet about Lee Hull and that seems to be the source of your ire. Be that as it may - what he suggests isn't particularly extreme, given the current NKF guidelines. Indeed, it was only my having unilaterally embarked on a very low protein + keto acid diet that saw me sat in front of of that rarest of beasts in my country: a renal dietician.
She's told me to continue with it and is intrigued by the prospect of exploring what for her, is the cutting edge of renal diet science. Furthermore, KidneyRD.com, board-registered renal dieticians take the same view - indeed they cite themselves as inspired to break into low and very low + keto diets at early stage CKD having, amongst other things, read Lee Hull's book.
Your contending against Lee Hull as you do doesn't stand up to scrutiny. He's brought something to the fore that needed bringing to the fore. Indeed, he a non-medic, a non-scientist, brought it to the fore before the NKF did.
Given so many on here report themselves as not being well served by their nephrologist, given so many on here report "good luck with that" when it comes to obtaining the services of a renal dietician, it's clear this gig cannot be left in the hands of a doc.
By the way: I'm following Lee Hull's suggestion of a supplemented very low protein diet under supervision and with the agreement of my GP, my nephrologist and a renal dietician. I may have taken the lead rather than have the diet suggested to me, but that's neither here nor there. I am navigating a well authorised path, one that happens to have been suggested to me by Lee Hull. You ought to have no objection to that.
If someone is inside the range that should be enough for most folks. I told you how I track the numbers and look for trends. Do more or less it's up to you.You found a dietitian, then work with that person, all you like. But almost every post you have you are questioning where the information comes from and you question the veracity of the information. That's what I said to refrain from being over-critical of what others are doing. You don't have to question the why, or how come... of everything. It's the path others have taken for their own reasons, much like the path you are taking. Do as much research as you want and go from there. There are a number of ways in the USA to contact and obtain the service of a renal dietitian. There is another community for those with CKD. Have you gone to that community and spoken to those folks? Bassetmommer gave you some insight on the factors involving the range of labs. If you have any question about that consider talking to someone at the lab(s) that your physicians use.
Skepitx, There are so many factors than fall within a lab. For example, if you have one reading on time and the numbers are off, then you might have been dehydrated that time.
Let's talk potassium. My reading is quite high on my last lab. But I was eating a lot of more high plant based potassium foods. As such, the one lab result demonstrated that. So now I cut back. Have I ever been mid range.... yes, a couple of times. The funny thing is that one reading, same diet, no differences, and the numbers can be different from lab to lab. This one was off because I had intentionally added higher potassium foods to see what would happen. And it raised my potassium... gee.
When it come to being mid-range.... think of it as a gage. So if you are persistently on the higher end, then there may be an issue. If your numbers consistently bounce around mid range, then I would say things are good.
BUT.... and any doctor will tell you this, it is just a very bias number to measure with. I have had higher readings in another area that are not midrange. But they have remained there my whole life. So for me, mid range of the doctor's chart would be low for me.
I think your question is shouldn't every one shoot for midrange. Yes and no. So much depends on what your body type is, and what factors such as weight and body mass have on that particular reading. And is this number current on its basis. Those numbers change through time. For example, have a A1c of 6 was healthy. Now it is 5 or less because...... well they can sell more drugs for one thing.
I take numbers with a grain of salt. I see something that for me has been riding pretty straight all of sudden take a turn up or down, I wait to see if that continues in the next lab and then if it does... we have a chat.
To repeat what have been already said I think it's a discussion to have with your medical team. It's all about context and it's for you to have that discussion with them and know where the concern are. You are barely getting started, you have to be careful not to set the bar too high .. or too low!
To some extent it can be done (my anion gap went to the upper limit to mid range) but I certainly would not use it as a pass/fail. In some case stopping a decline is a great thing, moving from out-of-range to above the upper limit can be a a life saver. On the other hand I wouldn't want to stay to bed all day just to improve metric X. But if my medical team tell me that I must then I shall comply. Cheers.
The ranges are based on averages of large populations. Do you need to be in the middle of the range? No. You should only express a little concern to your doctor if you are at the extremes of the range, and that should guide the doctor to keep a watchful eye and possibly look for other things at the extremes of their ranges. It's the combination of things that lead to diagnoses. Acid base balances are an example. Kidney issues are another. If the creatinine is out of whack, it is likely that other things are as well. If everything is perfectly normal except for creatinine, the doctor will simply keep a watchful eye and tell you to ease up on the protein. This has been my experience.
It is true..... kidneys decline with age. You just said it yourself. a GFR of 100 is a perfectly working kidney and yours was 84- 88. Look it up before you make a proclamation.
RESULTS: While all equations show declining function with age, our results suggest that the GFR reduction is progressive after the age of 30 and continue to decline steadily after the age of 60. This leads to a convex curve in the multiple regression analysis that is best fitted by an equation including the quadratic term (age(2)). ncbi.nlm.nih.gov/pubmed/187....
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Could you please help with my results
Lithium damage, need support
Lab work and no kidney damage
Is there such a thing as a healthy for your kidney breakfast cereal and some type of milk? 
I need help how can I handle this situation 
