Significance of eGFR dropping from 34 to 22 in 3 mo?

[nascar4433]

Recent labs showed eGFR dropping from 34 3 mo. ago to 22 last week. I see my nephro Thur, but am worried my kidneys are failing rapidly. Anyone else have a sudden drop? Been 34-36 for a year. Thanks!

[Sophiebun11]

Hi nascar,

That is a drop from Stage 3B to Stage 4. I'm glad that you have an appt. with your Neph. coming up this week.

Are you on a plant based diet? Has your Neph. discussed changing or stopping any medications you are on that may be harming your kidneys? Is your BP under control, or if you have T2D is it under control? Those issues can affect your kidney numbers.

Best of luck. Please check back after your Neph. appt. and let us know what his treatment plan will be.

[nascar4433 in reply to Sophiebun11]

Thanks for reaching out Sophiebun11! The only thing she had me stop was anti-inflammatory in June. Sept. labs eGFR stayed level. BP is well-controlled and just finished a bunch of cardiology tests and dr. said all looked good. No T2D. Been on Lokelma since June...started 3x/wk & #s improved slightly so dropped back to 2x/wk, but last weeks' labs showed increased again so cardio said take 3x again til my nephro appt. Stopped taking ibuprofen in June. No other drug changes. Had an appt with dietician that helped a little, but need more appts. Trying to reduce protein, but also have to follow low-residue diet for gastro issues, which makes it hard to increase plant-based natural foods. Also mix in low-potassium diet. It's all so confusing! Main worry is the big drop in eGFR into Stage4. Wonder if it's possible to increase it. Obviously anxious for nephro diet to see what she has to say. Thanks for the encouragement!

[Sophiebun11 in reply to nascar4433]

A plant based diet can help. I have gastro issues and swallowing issues from my autoimmune disease, Scleroderma, which is now attacking my kidneys and the cause of my CKD.

You should be able to keep to a plant based diet. Plant protein is so much better for your kidneys. 80% of plant protein is digested by the body so the kidneys only have to remove 20%. With animal protein only 30% is absorbed and the kidneys have to remove the rest which is hard work.

Make sure you are seeing a Renal Dietician, not a regular Dietician. I have a lot of dietary restrictions with Celiac, IBS and lots of food allergies and Malabsorption. A plant based or vegetarian diet is easier to manage with those issues and a low residue diet like FOD MAP.

A plant based diet is the single best thing to do to improve your kidney numbers. There's no reason anyone can't be on a plant based diet, it's all just getting used to a new way of thinking about food. You can get protein from Nutritional Yeast rather than nuts, whole grains, and seeds.

Ask your Neph. My neph was surprised to see that my egfr was 28 yet I had no protein in my urine and my potassium was a little below normal. I told him I'd been a vegetarian since I was 10 years old and he said that was probably why everything looked great except my egfr. If it weren't for my autoimmune disease I wouldn't have CKD since I have no other risk factors.

I went back up to Stage 3 after I hit Stage 4 so it's possible.

Keep up the good work.

[nascar4433 in reply to Sophiebun11]

Thanks for the info. I'm sorry you have so many health issues. I have an autoimmune as well, Sarcoidosis, but so far nobody thinks it's the cause of the CKD. The nutritionist I saw said she was trained in renal, but I may see her associate who has credentials in renal stuff. I'll ask my nephro again. I know their practice handles dialysis, etc., so perhaps once you get into Stage4 they have someone in-house. I researched the nutritionist I saw and asked my nephro for the referral, so perhaps I should trust them. I obviously need more than one appt with them! Depending on what she says about the eGFR drop, I'll go back and ask for specifics on a plant based diet that's also mindful of the gastro & swallowing issues (severe gastroparesis & dysphagia). I appreciate your info & encouragement! Take care.

[Sophiebun11 in reply to nascar4433]

You don't need dialysis in Stage 4. You won't need it until you get into low Stage 5 which is a long way to go still. Don't even worry about it.

There actually is a relationship between CKD and sarcoidosis as with many autoimmune diseases. Read this study under the "results section".

sjkdt.org/article.asp?issn=....

The patients in the study had positive results on Prednisone treatment just as my Neph started me on prednisone and my EGFR went back up to Stage 3. He may also add me on CellCept.

Aren't you seeing a Rheumatologist? They should know about the connection.

[nascar4433 in reply to Sophiebun11]

Thanks for the info. I'm glad to know your eGFR went back up. I'm definitely going to look into plant-based. No, I haven't seen a rheumatologist in many years. I appreciate your positivity and info.

[Jayhawker in reply to nascar4433]

I’ve had three sudden, major drops in my eGFR (90-49, 49-16, and 29-8). There was some improvement after my second plummet as you can see from the data I shared.

I plummeted into Stage V, eGFR 8, the first week of January 2017. My eGFR stayed 8-9 for a little over a year. No dialysis though. It then inched up to 10-11 and stayed there for about a year. It then inched up to 14-15 and stayed there for about a year and a half. This past year it bounced quickly up to 19-20. It has been stable at 19-20 for the past year.

I converted to a modified plant protein diet following my renal dietician’s guidance in July of 2019. I eat a whole egg with extra egg white three days a week for my evening protein. I eat plant-based protein three nights a week for protein at dinner time. I have boneless skinless chicken one night a week for dinner. I have a serving of a renal, diabetes friendly liquid protein at lunch each day. It is plant based. I often put this into a fruit smoothie. Then I have steel cut oatmeal for breakfast.

This conversion in my protein intake has helped my kidneys rebound. I’ve also been chronically dehydrated since 2013 due to my original CKD treatment plan. The dehydration caused real problems with low BP and sudden drops in BP (as often as 6 times a day.). So, for me, dealing with the hydration effectively over this past year and a half likely lead to my my most recent improvement.

This stuff can be pretty tricky to balance.

Jayhawker

[nascar4433 in reply to Jayhawker]

Jayhawks, thank you so much for taking the time to provide such detailed information. It helps to hear specifics on your diet, especially that you're doing well on a modified PB diet. I've been reducing my protein intake, and working on figuring out the whole WFPB diet...what's ok, what's not, etc. It's going to be a journey, that's for sure. When you said it's tricky to balance, I couldn't agree more! But you've given me hope that my numbers can improve with making dietary changes, and that i don't need to panic with the drop in eGFR. I feel fortunate to have a nephro I like and trust, and that she immediately made changes in meds, advised foods in eat to increase iron (still low even tho I've been taking Slow FE for 3 mos.), and that she's having me do labs in 2 weeks rather than waiting. Good luck in your health, and thanks again for the info you provided. Take care.

[Chimama]

Were you maybe dehydrated for your labs? I know tgat made change in mine fro 36 to 41 gfr

[nascar4433 in reply to Chimama]

Thanks for asking. I don't think so, as I always try to drink even more before labs cuz I'm a hard draw. I'll ask my nephro. Perhaps we'll do new labs, and I'll make sure to be well-hydrated.

[RhenDutchess123]

It usually takes 3 sets of Labs to confirm a GFR drop...lots if reasons for this and may be temporary

[nascar4433 in reply to RhenDutchess123]

Thanks for the info. I saw my nephro and discussed the drop as well as other problematic results, and she changed several meds and is having me repeat labs in 2 weeks, then see where we go.

[mybirdbuddie]

Hi Nascar, yes, a month ago I was in hospital with fluid on my lungs due to conjestive heart failure and I was stage 3b . Within 2 weeks I am now at stage 4 ..25...but have had no referral. Basically, it has been requested that my bloods are regularly checked..and that's it so no referral ......amazing how differently hospitals, countries react...very worrying for me at the age of close to 85 years....makes me feel neglected.

[nascar4433 in reply to mybirdbuddie]

Mybirdbuddie...I'm sorry you're feeling neglected. Push for referral to a nephrologist. Don't let them tell you that you don't need to see one. Save as much kidney function as you can...and how can you do that if you don't have a specialist looking out for you? I hope you start feeling better. Nice that you're up on technology at age 85...you go!!!

[Uckle in reply to mybirdbuddie]

I have fluid on my lung it is called pleural effusion. I get the fluid drained 3 times a week. I havent seen anyone on this group ever mentioning this.I am 91 years old. Were they able to cure it. I hope so.

[nascar4433 in reply to Uckle]

Oh my, I'm sorry you have to go through that so often. 91? Wow...congratulations! Great that you're using technology...so many in our aging population don't do that...keeps you young, right?!! Good for you. My nephro changed some meds and is repeating labs in 2 weeks. Thanks for asking. Take care.

[HSV21]

Hi Nascar,

I understand your concerns and fear. When I realized (from my own research, not because my nephro told me) that I had been in stage 4 for 9 months I really panicked and became quite fearful of dying very soon. That was an over reaction and I am much calmer now, but still have bouts of deep concern. I spoke with my PCP and changed nephros and luckily found a great renal dietician. It is horribly confusing to know what to do and not do, especially with diet. I have changed to a plant -based diet, but because I have Type 2 diabetes, must also include 8 oz. of protein per day. I have congestive heart failure too, and it is all such a delicate balance. Stage 4 really sucks, but the best I can say is find a renal dietician who will be very personal with you and answer every question you have. I made the mistake of trying a dietician my insurance suggested, and while she had renal diets in her far background, I found her sorely lacking in knowledge of Stage 4, in that I knew more than she did. So I was very happy when my insurance gave me the approval to use anyone I wanted. Are you in the U.S.? If so, private message me and I can give you my dietician's info. If not, best advice I can give is write every question down and make your nephro answer them to your satisfaction. Then do the same with your dietician. If you are not happy with either of them, change. There are many quacks and professionals out there with motivations that may not be in your best interest. Listen to your gut instincts, do as much critical reading as you can, and keep being your own best advocate. Some of us on this site, including myself, may give you advise that is right for them, but may not be right for you. Every situation is different and unique. Just do believe, however, that we are here to support you, encourage you and try to help you through this new journey. I have learned a great deal here and have been tremendously encouraged as well.

[nascar4433 in reply to HSV21]

HSV21...thank you for your wonderful note! It made me very happy. My nephro has a good reputation, so I'm happy so far. Will see what she has to say about the eGFR drop tmrw. I only saw the nutritionist/dietician once, and have another appt in a couple of weeks. I guess it went OK, but I was hoping for more specifics for my diet. Hopefully will get that at the next visit, otherwise may change, altho my research said they were supposed to be good. May see her partner who has more renal experience credentials. She did say that my ins. would pay for her because of the diagnosed CKD, so was happy about that. With the eGFR drop I may have to look for another specialist, but will see her once more before I decide, and see what she says now that it's Stage 4 rather than 3b. You're right! It's all so confusing. I have days when I Google a lot and others I just try not to think about it. But I know I can't hide my head in the sand. Several people have mentioned plant-based diets as you did, so I'll get serious about that next. I'm sorry you have congestive heart failure as well as kidney disease. I feel fortunate my cardiologist says things are going well. Thanks for the encouragement! Take care of yourself. (Yes, I'm in the U.S. I'll try to figure out private messaging. Thanks for offering to help)