Did My CKD Progressed?

[Jten]

Background: Diagnosed w/CKD Stage 2

Recent labs: Protein in urine

Next steps: Doctor ordered a 24hr urine test

Meds: Lisinopril

Question: Does protein in urine indicates that my kidney disease has advanced in stages? Has it progressed?

[Bet117 NKF Ambassador]

Hi Jten,

Welcome!

In response to your question; many factors could influence the protein in your urine. If you are at stage 2 CKD and have no changes in your creatinine, GFR, BUN, electrolyte levels; all to your advantage. You are in a positive place.

Are you diabetic? Are you attentive to your diet; drinking plenty of water, avoiding red meats and processed foods? Are you limiting your sodium intake to 1500- 2000mg daily? Eating fresh fruits and vegetables; baking, broiling or grilling and avoiding frying? Avoiding dark colas and NASID pain relievers as Advil? Have you been under stress lately or heavily exercising? All to note.

As far as ordering a 24 hour urine catch; your doctor is being thorough. Honestly.

As much as it is an annoyance, a 24 hour catch is considered to be the gold star marker among nephrologists as it is an average of all of the elements of your urine over a 24 hour period; similar to an A1C marker which indicates glucose levels over a 3 month period.

This is considered to be a better marker as opposed to one sample which can be more varied depending upon the time of day, hydration etc. that it is given.

My nephrologist requires a 24 hour catch prior to each appointment and I also leave a sample when I come in.

I am a Membraneous Nephropathy patient and also take Lisinopril. It is one of the two drugs most highly prescribed drugs in the US for kidney patients and also diabetics.

It is given to me to protect the kidneys and is used as a first line drug to eliminate protein in the urine in addition to reducing high blood pressure; if the person has that as well.

Please sit tight with all of this as its a process to get to the bottom of why you are spilling protein. The important thing is that it was caught and is being addressed.

Once you have completed all of the labs that your doctor has ordered; print out the results and check off any areas that may flag high or low next to the given ranges. Make a list of questions; diet, progression; labs as well as concerns and bring them to your medical appointment.

Take notes and have him/ her explain your labs and answer all questions and set you on a medical action plan before you leave the office.

Stay positive and please reach back and let us know what the outcome is. You are among friends in this great community.

Bet

[Jten in reply to Bet117]

Hello Bet117,

Thank you so much for your thorough response. Much appreciated.

[Bet117 NKF Ambassador in reply to Jten]

Hi Jten,

No thanks ever needed! If I can be of support; please feel free to reach out.

Know that you are on the right path.

Stay safe and positive!

Communicate soon!

Bet

[Confuseddiabetic in reply to Bet117]

My Doctor feels that the 24 hour urine is a better measure of kidney status than the EGFR.

[Darlenia]

Hi Jten. When your doctor orders lab reports down the road, often eGFR (estimated Globular Filtration Rate) is included. Some labs include controversial race weighting in that eGFR number that can prevent those in the black population from getting proper care. If this matters to you, ask your doctor to take that out of consideration when he looks over the results from any of those labs. Sending encouragement your way that all turns out well for you!

[Hunt70 in reply to Darlenia]

I noticed that change too due to race ..I have been reading I think they are trying to have it removed as it is confusing to those who are dealing with CKD

[Darlenia in reply to Hunt70]

Yes, some have dropped it. It will be a great day when all labs drop it. Optimum treatment is a right for everyone.

[Hunt70 in reply to Darlenia]

Totally agree I thought we are all flesh and blood ...when I saw the options of race I was questioning why it was put into blood work...I think our heritage may make us prone to different things but then we will be looking at DNA and that even keeps changing as technology moves forward. ..I had my ancestry DNA done and I get updates as it gets more fine tuned it's actually mind boggling..plus my mom was adopted ..not looking for anyone I kept all anonymous just wanted to see my heritage but they offer DNA stuff related to health stuff too ..crazy but not going that far into it perhaps for a young person worthwhile...

[Darlenia in reply to Hunt70]

Yes! DNA is valuable for medical decision making but race is a distraction. And I'm an older white lady who also questions things. I appreciate that you, too, feel like I do! Thank you!

[Hunt70 in reply to Darlenia]

I am Caucasian but I as soon as I saw the difference in blood work it got me thinking why ha ...we evidently were not alone in wondering why there was a difference..

[Blackknight1989]

eGFR and UCAR are the two tests that are recommended by NKF, ASN and NIDDK to measure both the current stage and progression of CKD. Labs in the US are required now to use the race neutral eGFR calculation as noted in both the NIDDK and ASN news releases from early this year so of your doctor is not using a lab with the correct eGFR calculation a request to change is in order. There are several methods of eGFR calculations used and the research that led to the recommendation to remove race from the eGFR calculations also reduce the calculation methods from over 20 to just 5. The NIDDK has several articles as which to use when and several offering good lay explanations to patients. For those with more aggressive research goals, the physicians reference for NIDDK and the ASN website give further recommendations to physicians but are available for us to read, in fact the ASN has an even more rigorous eGFR recommendation than any other site I can find.

Generally, if this is the first time you have tested positive for blood/urine proteinuria the tests should be repeated. If it was just a one-time urine draw, the 24 hour urine test is a better indicator than a normal urinalysis. However, for other kidney function indicators the 24 hour test is almost obsolete according to several research based sites like ASN, AKF, NKF, NIDDK and others. But if you are leaking protein as verified by testing and it is the first diagnosis if it continues it will help hasten CKD progression so the need to find the underlying cause is paramount. Again, several sites like NKF, NIDDK and others can back this up. Also, see PubMed or MedLine for the research studies about the damage protein can do to the kidneys.

All information is obtained using US based sites.

Links can be provided but the information is fairly easy to obtain and can help CKD patients become better advocate for their own health.

Just my opinion.