ACR Ratio Confusion

[lakeheadguy]

My PCP has issued labs to monitor my kidneys. To date no formal diagnosis.

My blood sodium, potassium, creatinine; always in the normal range.

My urine pH, Protein, Glucose, Ketones, Erythrocytes, Nitrate, and Leukocytes are also always in the normal range.

Two generations of Acute Nephritis in family medical history (maternal side)

Shadow on liver

Multiple UTI and bladder infections

ACR goal <2.0

October ACR unable to calculate, eGFR 58

Albumin <5 g/l (goal is > 4), Creatinine 1.8 mmol/L (goal 3.5 - 24.5 mmol/L)

July ACR 2.7, eGFR 51

Albumin 6 g/l (goal is > 4), Creatinine 2.2 mmol/L (goal 3.5 - 24.5 mmol/L)

April ACR 2.5, eGFR 56

Albumin 9 g/l (goal is > 4), Creatinine 3.6 mmol/L (goal 3.5 - 24.5 mmol/L)

March ACR Unable to calculate, eGFR 56

Albumin <5 g/l (goal is > 4), Creatinine1.9 mmol/L (goal 3.5 - 24.5 mmol/L)

February ACR 3.7, eGFR 60

Albumin 13 g/l (goal is > 4), Creatinine 3.5 mmol/L (goal 3.5 - 24.5 mmol/L)

Pattern

When the albumin increases the creatinine increases.

When the albumin decreases the creatinine decreases.

Why the fluctuation?

ACR goal <2.0 need to increase albumin and/or creatinine?

What does this mean? CKD, or liver disease, or infection?

Ontario government supplied PCP so can't change.

[orangecity41 NKF Ambassador]

Attached is link to information on ACR from National Kidney Foundation. kidney.org/kidneydisease/si...

We are not able to diagnose on this forum. Perhaps get a second opinion of another Doctor on your test results.

[RoxanneKidney]

That is albumin in the blood serum, but what about the urine? What is going on in your urine. Have them do a 24 hr. Urine and see how much creatinine you are excreting as well as protein. Also Cystatin C test is the gold standard of GFR and does not fluctuate like creatinine, so more tell, especially if you are muscular. You should also have a sonogram on the kidneys to determine if there is any blockage due to the UTIs, you can also get the filter flow rate and size etc. There are many other non invasive tests, but if have protein in your urine and you do not have diabetic issues or high BP etc. Get a biopsy, because protein is a marker for progression...the more protein in urine the higher the speed of the train. Last if you have not changed your diet and are still eating a lot of meat, good luck with that. It has been respected over and over again that a plant based diet can slow progression. Salt is a kidney killer too. Keep us posted.

[lakeheadguy in reply to RoxanneKidney]

Urine ASR not blood. Not muscular. Acetylcoline Receptor Antibody Qualitative negative. Muscle-specific tyrosine kinase (MuSK) Antibody negative. Protein 50-70 gm past 3 months. Ultrasound negative but kidney larger than normal. No protein in urine. Confused what should I do? Only doctor can diagnose (wait for ?)

[WildIris]

Sounds like your labs are pretty good, your family history a bit alarming, your doctor careful. I'd want to understand the few abnormalities too. Part of me wants to say relish your pretty good health, but I completely get it- the earlier you make some changes, especially for kidneys, the better. A lot of people on this site got good results from a plant-based vegan diet, so you could try whatever part of that approach appeals to you? Good luck!