help me understand the significance of this pathology and blood tests

[Teekay2]

Hello, I had a radical left nephrectomy end of March this year. No complications.

I had a letter which stated:

“Pathology was graded as a T3a initially but after re-discussion it is downgraded to pT1a a likeley pathology. I will be on intermediate risk surveillance.

Just seen my recent blood test results online. I cannot understand them but note there is plenty of red.

It will be a month before I get a telephone consultation.

I would much appreciate it if someone can help me understand the significance of this pathology

and blood test results.

[Jwbak]

I had a radical nephrectomy with adrenal gland in March of 2023. Unfortunately I had complications which caused an acute kidney injury. Waking up to the world of kidney disease can be confusing and scary.

A few things that made it easy for me to understand my blood work. Estimated GFR is the big one and it can most easily be understood as a percentage of kidney function, you are at 36% right now. It's estimated because they do some math on the numbers to calculate the GFR based on your blood work. There is an actual GFR test that uses tracers in the blood and measure how much you filter out.

GFR is calculated using your creatinine (normal muscle breakdown removed by the kidney) levels along with other factors such as age, weight, and height, etc. GFR below 15 is generally when dialysis begins. Creatinine in itself isn't toxic, it's just an indicator of your kidney function.

Your blood urea (which I believe in BUN in the states) is produced from the breakdown of protein and is removed by your kidney. Another factor to look at when looking at kidney function. My understanding is the main purpose of dialysis was to remove blood urea nitrogen.

When I got out of the hospital a month later I was at 6 GFR and had to do dialysis, a year and a half later I am at 35 GFR.

I asked my nephrologist what I should expect my GFR to be if I didn't have any complications after my nephrectomy and he said that you generally lose 10% function compared to your pre-surgery GFR. Your other kidney almost completely takes over, but it takes a little time. In other words it's not as simple as each kidney does 50% of the work, which is good news.

You are still early in the process so hopefully your GFR will improve. They didn't really know what to expect with me and had no timeline. I increased by 5 in my last blood test which surprised my nephrologist. That is a single blood test though, you want to look at the trend.

I see at the bottom of your blood work under acute kidney injury that it says high. Not sure what that is but you might want to ask about it. They are probably in wait and see mode right now.

Most importantly talk to your nephrologist and remember to ask questions, because they generally don't offer up much explanation in my experience. I am just sharing my experience so far so take what I said with that in mind, I'm not a doctor.

[Teekay2 in reply to Jwbak]

Thanks for that. It's helpfull. Wishing you Well.

[userotc in reply to Jwbak]

You may also be interested in my reply to OP due to similarities in egfr etc for you, him, mum following nephrectomies.

[userotc]

You may be interested in a post I did earlier in the year on single kidney-ers with ckd which you can find by searching my posts (clicking on my name etc).

After her nephrectomy >7y ago, she also had egfr 36 which her nephro was satisfied with but we weren't. We gradually got it to 76 a couple of years later but it has trended lower since so our main focus is on trying to get it back to where we might expect/hope for single kidneyers.

There's insufficient space here to explain as much as I can but hopefully the earlier post helps.

[Darlenia]

You've received some great answers. My husband has one kidney too, a transplant. I just want to let you know that it's rare to get full function from one kidney - generally you'll get no more than 85% function according to my husband's nephrologist. And then age sets in, too, often reducing it further over time. I simply want to point out that all the rankings and rating for kidney function are based on two kidneys - so it's always a bit alarming that things are flagged. I'm sure your nephrologist is aware of that and will keep that in mind as he monitors you But the main thing I'd like to say is that it's completely possible to lead a nice long life with one kidney as long you stick to a nice weight, don't damage it via accidents, keep a good blood pressure, etc. Mother Nature provides us with two kidneys - one and a spare - to carry us along. Thankfully.