Initial Kidney Disease Workup

[CN67]

My husband had efgr of 58 and creatinine 1.49. All other bloodwork was normal. He is overweight and we have just learned from regular testing, has mildly high BP. The nephrologist said she needs to rule out a bunch of causes and ordered a ton of tests. I’m wondering if this is standard, or if she is just very thorough, or if she is particularly concerned. He is 47.

She ordered all Hepatitis screens, IPEP, SPEP, UPEP, C3& C4, Cystatin, urinalysis for albumin/ creatinine ratio, creatinine kinase, and ANA in addition to another cbc/cmp. Also a renal and bladder ultrasound (post residual) Is this typical? I’m concerned about all the light chain tests. I know what they check for and would like to know this is always checked with a decline in Kidney function.

Thank you.

[Vcr1406]

It may be she is concerned because he is so young. I wonder why he was referred to a nephrologist with a gfr of 58. I would think his pcp would at least recheck gfr in a few weeks after a low reading to see if kidney function had increased. I hope his insurance pays for all this and that he is not being charged for unnecessary tests. Actually, 58 is not really anywhere close to kidney failure and referral to nephrologist is premature.

[CN67 in reply to Vcr1406]

Thank you for your reply; I greatly appreciate it. From what I read he isn’t so young for CKD?

Looking back now, we can see his creatinine was slowly rising and his efgr slowly declining for the last 6 years. His last physical in 2020 showed efgr of 59 and creatinine of 1.35. At the time he was taking Advil and pcp said don’t worry; the numbers were from that.

So in 2 years, efgr went to 58 and creatinine to 1.49. The numbers over the years were always in range but PCP never mentioned them worsening.

I’m really nervous. So far we got cbc back- all normal. Cystatin C is 1.02 with ref range up to 1.0, so slightly above. Urinalysis has always been perfect. Albumin/ creat urine ratio normal. C3 and C4 normal. Hepatitis screens negative. Just waiting on all the light chain tests and ANA.

Are these tests all nephrologists do to find cause?

[horsie63 in reply to CN67]

Sounds like you have a good nephrologist. Mine did all those tests when I first saw him (he's the second neph I've had as the first was unconcerned). These tests are the least invasive ways to try and determine a possible cause. More invasive is a biopsy if none of the others help pinpoint the cause. I recently had a genetic test due to other issues I have and one of the gene mutations can cause kidney failure along with my retina and hearing issues. It's better to know and take steps to stop or slow progression.

[drmind in reply to horsie63]

I totally agree with all the tests. The sooner he gets a handle on what is causing the decline, the faster he can start working on stopping the progression. That old school notion of waiting for a nephologist referral until you hit stage 3 is dumb and something a lot of us complain about. I wish I knew I was having kidney problems 5 years before the doctors told me.

[Darlenia]

Yes, all of those tests (and more) are often necessary when a nephrologist is looking for or tracking down the reason for a steady decline in kidney function - whether it's diabetes, infection issues, a medication problem, an autoimmune condition, and so on. The quicker the reason is found, the faster the decline can be stopped. (My husband's condition led to dialysis which didn't need to happen.) So, your husband is exceptionally fortunate to have a proactive nephrologist working for him. I know it's difficult to do, but trust the process. Your hubby likely will have the answer soon. And the situation can be taken care of appropriately. A win for him, and a win for you!

[CN67 in reply to Darlenia]

Thank you; I really appreciate your help.

[edrauch]

I was very similar last year after my blood work. I since have lost 15 lbs and eat very healthy with very little red meat, low saturated fats, and low sodium everything. I was taken off my BP medicine , potassium and cholesterol is so low now we are testing getting rid of that medicine also. My creatinine came down to 1.17 and efgr went back up to 66.

[KidneyCoach NKF Ambassador]

Is he still using Advil (NSAIDS)? They aren't kidney friendly.