Concerned about kidney function numbers going down

[AirCon78]

Hello all, glad I found this forum. There is great information and feedback here.

For a long time my blood pressure has been in the pre-hypertension range. I've worked actively to bring it down and it's been hovering between normal/pre-hypertension for a few years now. My doctors don't want to put me on BP meds.

For the longest time, my EGFR has bounced around in the 80's (occasional drop to high 70s) and my my Creatinine has bounced around the 1.0-1.2 range. BUN between 15-18. According to kidney.org, anything below 90 eGFR is already damage to the kidneys.

However, the last few blood tests, my EGFR dropped to the high 70s.

I recently had an MRI with contrast done (due to tiny cysts on left kidney) and I had bloodwork done afterwards because of flank pain/discomfort and I was taken back by my numbers.

My EGFR dropped to 71 and my Creatinine was 1.2mg.

Is this something I should be concerned about? My doctor doesn't seem concerned and says my numbers are still normal. My concern is that my numbers seem to be creeping downwards (and up for Creatinine).

I've had a few urine tests in the past where there was trace amounts of protein in the urine, but it's been negative the last 3 times I had a urine test.

[WinJ3]

Listen to your doctor…..I wish my number was like yours.

[AirCon78 in reply to WinJ3]

Thank you for the post.

When do the numbers cause concern or what are the trends that I should keep an eye on?

I've read numerous instances where people had good but not great numbers for a while, and years later, they got to the point where they had CKD.

[Skeptix]

How old are you? It's normal for kidney function to drop off with age. That said, doctors not telling patients that they've something to worry about isn't exactly a rare phenomenon, from what I've gleaned from this site/own experience so good to enquire (but not panic)

[AirCon78 in reply to Skeptix]

I'm a 40 year old male.

My brother is 3 years older than me and he just had his annual checkup and his eGFR reads as 103. =/

[Skeptix]

There's a lady just joined the site whose doctor didn't tell her she had a problem and her gfr was down to 24!

The safest thing to do is ignore the advice of a doctor who says there is nothing to worry about until such time as it's established that you've nothing to worry about!

That said, "worry" wouldn't be the first position I'd occupy at your (high) level of function. But certainly inquiry would be appropriate. According to kidney.org you should be around your brothers numbers. 70's is on the low side by that measure.

You say "the longest time".. If you put creatinine 1.2 into an eGFR formula age 25 / white you'll get eGFR 84. Put the same thing in age 40 and you'll get 75. So there is going to be some age related decline. That said, 70 sounds low for your age.

I'd do a bit of reading around here, read the NKF website then ring your doctor and ask why it is he doesn't think there's an issue. If you don't get a satisfactory answer, find another doctor. Finding another doctor is a very common refrain around here. Indeed, someone referred to "firing" their doctor, which is a good way to think of it: you as employer.

BTW, creatinine is the only serum marker whose number goes into a formula to arrive at eGFR. The other numbers are things like age, race-based adjusters, etc. So creatinine up / eGFR is two sides of the same coin.

[AirCon78 in reply to Skeptix]

Thank for the details. So are other numbers just as important to estimate kidney function (BUN, protein check in urine, etc.)? Unless I mistakenly assumed that Creatinine was the most important factor in determining kidney function.

[Skeptix in reply to AirCon78]

Creatinine is used to estimate kidney function because it's a waste product that is produced on a reasonably stable basis by the body. It going up correlates reasonably well with declining kidney function.

Now a weight lifter will produce excess creatinine even though kidney function is okay. Or if you had a big load of meat (that contains creatinine when cooked) prior to testing then that would skew the results. But generally its a good way to estimate.

Creatinine isn't kidney toxic generally. Whereas urea is. So if your urea results were up, that would be something I'd pay more attention to than creatinine. And urea is something you can directly affect with diet whereas creatinine less so.

Etc. Etc.

You've got a lot of function. I'm at 30 (or was last blood and before I embarked on serious dietary change) so have more reason to get up to speed and pay attention. Then again, I'm 57 and you're 40.

Take it as an early warning shot across the bows. Somethings going on with you and you're going to have to take control of the reins in finding out what and what to do about it.

Good news is that it appears you can. Kidneys, like everything else, seems to respond to a little TLC!

[Sarah_402]

Hi AirCon78, I just wanted to share with you that I'm also in my 40s and my physicians said nothing about my eGFR being in the 70s , 60s, or 50s. Those numbers were when I was in my 30s. Now at 45 years old, my eGFR is 44. And my physicians are looking in to it now. Most of my eGFR results were reported as >60. However, a eGFR in the 60s, 70s, and 80s, would not be normal for my age group. I am disappointed that my physicians did not warn me earlier so that I might have had a chance of slowing down the progression. Maybe most physicians don't treat until the eGFR is low, but if your not informed than you have no choice of any interventions. I'm new here, but many nice members have said changes in diet and exercise can help. Also maybe talk to different physician or your physician again and explain your concerns about your kidney function and higher blood pressure. They might prescribe a medication that could help you, if they hear your concern about not wanting this to progress. Good luck AirCon78!!

[AirCon78 in reply to Sarah_402]

Thank you for the post.

That's what frustrates me. I feel like alot of doctors are about "reactionary" care rather than "preventative" care.

Even though above 60 eGFR is normal, according to kidney.org between 60 and 90 already indicates some form of kidney damage.

I feel like slow downward progressions should be looked at to find the root cause, instead of waiting till it gets bad and then reacting.

[Sarah_402 in reply to AirCon78]

I totally agree.

[Skeptix in reply to AirCon78]

You'd think so .. prevention better than cure and all that. Two things though:

It appears to only very recently that dietary intervention as a way to treat early stage kidney disease has come to the fore. Doctors appear to have been operating according to NKF guidelines issued in 2000. They don't have early stage intervention (presumably because the science then didn't indicate so). You hear it time and time again: no action till end stage

The 2020 guidelines, based on more recent science, that advocate earlier intervention.

My own nephrologist was following the 2000 route. Do very little until end stage. It was me who decided I'd implement a very low protein diet - it made sense given my urea was well out of spec.

It will take years for the latest science to roll down to clinical practice. Consider: there aren't enough renal dieticians around to implement early intervention now. The dieticians there are are all focused on end stage/dialysis/transplant patients. That has been the paradigm so there hasn't been a need for any more dieticians that required to serve that market. What is to happen if a shed load of stage 2 and 3 patients come knocking on the door? Where are these renal dieticians to come from? Out of the woodwork?

You would, typically,need renal dieticians to oversee radical dietary alterations (low or very low plant based diets aren't something you can just embark on and hope for the best)

As my own renal dietician points out, there isn't the money to fund a pile of early stage intervention. Eventually it will make sense budget wise as the reality gets through to those managing the health systems. But it will be years before that happens.

[novemberlady1 in reply to AirCon78]

YOU ARE SO RIGHT. ITS LIKE I TELL MY SON WHO IS A COP. A GOOD COP SHOULD BE PROACTIVE AND NOT REACTIVE, SAME HERE . I WISH I HAD BEEN MORE PROACTIVE HERE BUT I WAS ALWAYS CONCENTRATING ON MY DIABETES AND NOT MY KIDNEYS .

[WinJ3]

Check out this chart by the National Kidney Foundation.

kidney.org/atoz/content/gfr

Now is a good time for you to be concerned about CKD, because it gives you a great chance to preserve the rest of your kidney function. Don't trust your doctors to be concern about your Kidneys until they get really bad and showing symptoms. Doctors are train to treat diseases and not to prevent them. My doctor was only concerned about my Kidneys until I was at stage 3 and had symptoms.

The best advice I give you is to visit this site and go through this free kidney module:

Kidney School:

kidneyschool.org/

Best wishes for you,

Win

[Tuolumne]

There's no reason why you can't start improving your diet now. Maybe everything is going to be okay, maybe this is temporary, maybe it's no big deal. But maybe the numbers are just going to creep down lower until you're officially in Stage 3.

When I was diagnosed with Stage 3a kidney disease I knew I didn't want to go against my doctor's orders, but I also knew I wanted to do more than just "cut back" on salt and drink enough water, which is all he suggested. That seems to be just the bare minimum.

So I investigated online, learned that a plant-based diet can be very helpful for the kidneys, and also low-acid diet. It's too soon to know if the diet is helping (but I am confident it will in time) but it's not getting worse.

By changing your diet, "just in case" your kidneys are in real trouble, you're getting ahead of any potential decline in function. I'm sure all of us here would have loved to have a GFR in the 70s but know what we know now about how much diet can help. We'd probably still have a GFR in the 70s or higher!

My doctor is okay with this diet (he seems to shrug like it couldn't hurt), so I feel I'm on safe ground.

These links could be helpful. ncbi.nlm.nih.gov/pmc/articl...

thekidneydietitian.org/pral/

[AirCon78 in reply to Tuolumne]

Wow, i didnt realize chicken had more acid than beef. Ive been trying to avoid beef and have eating more chicken and fish. I guess vegetarian may be the only sensible option.

[LoveNeroli in reply to Tuolumne]

Thank you so much for the link to The Kidney Dietician. I am finding it very useful indeed.

[LuvSmallDogs in reply to Tuolumne]

Are you still taking Albutrix, or getting your protein solely by your diet now?

[RoxanneKidney]

Yes, I would be concerned. If I knew what those numbers meant when I had them that high, I would have been concerned too.

[RoxanneKidney]

Yeah, and get your protein checked in a 24 hr urine collection. My creatinine was always hovering over 1.0 and protein was the issue. All other number were always good. Still pretty much are...Except the GFR due to protein damage.

[AirCon78 in reply to RoxanneKidney]

Im scheduled to get a 24 hr urine test. How accurate are cystatin c tests? I asked my doctor about it but dr told me that 24 hr urine test is still the golden standard and wasnt really keen on doing cystatin c.

[RoxanneKidney]

If your GFR is over 60 then the creatinine isn't as good, and if your GFR is below 60 and the creatinin and cystatin C is also below, it basically confirms the creatinine test. And if the C is above 60 and the creatinine is below, it is basically good news for you. If it is below, some labs do an average of the two tests.