Doctor made no comment on GFR of 58 - Why?

Hi I am new to this site and arrived here after analysing my blood test results.

I am 71 next month.

I was extremely and unusually fatigued so the doctor arranged a number of blood tests. I telephoned for the results and was advised that all were normal. I then requested a copy and discovered that my GFR was 58 ml/min/1.73m2.

A urine dip stick test has since found repeat haematuria and proteinuria. I have no pain or urinary infection but twice the top normal level of pus cells. How concerned should I be? What should I do next?

I am left wondering if the 'normal' response was incompetence, or ageism!

27 Replies

  • Hi,

    I am 72 and have been at stage 3 [ GFR of 38 ] for a many years, so i wouldn't worry too much with a GFR of 58 I also always have a "trace" of blood in my urine which is normal for me, I sometimes have traces of proteinuria. I do get quite a few urine infections which need to be treated with antibiotics, so I have regular blood and urine tests, usually most people are not referred until they reach stage 4 but it can depend on your Dr.,

    I'm sure the more expert on this site will have more info. for you,

  • Hello bowler

    Thanks for you reply.

    I would be interested to know why you 'always' have a trace of blood in your urine.

  • Hi

    Many people can have a trace of blood in their urine and wouldn't know it as it can't bee see by the naked eye, My GP said it's nothing to worry about, and as I am at stage 3 I do have regular blood and urine tests.

    And as you are seeing a urologist then he/she should answer your questions.

  • Hi bowler

    Thanks for your further response to my question.

    Can I assume that you have had all the tests done to determine the cause of the microscopic blood? Have you had a cystoscopy, ultrasound and or MRI scan?

  • I have had a Cystoscopy that was all clear, and as I am female I had some gynacology tests, some atrophy and fibroids were found, obviously that wouldn't apply to you being male.

    I have also had a kidney scan, nothing sinister there, but they did say I had one kidney slightly smaller than the other.

    My husband had prostrate problems and passed some blood but that was very visible, not just a trace.

  • Hello again bowler. Well that is good that you got all the appropriate tests done to give you peace of mind.

    Prior to my prostate laser surgery I once had a frightening episode where I literally filled the pan with bright red blood.

  • To make it easier for people to comment, is the doctor a primary care provider or a specialist? Also, are you male or female? It's good that you asked for a copy of the test. I don't know whether you live in UK or the US, but it seems that in most places these days doctors communicate as little as possible. My original test results were similar to yours, and I referred myself to a nephrologist. I continue to see her on a regular basis and my condition remains stable. From what I've read, neither transplants nor dialysis are recommended for people of 65, and you are nowhere near needing either.

    Be glad your doctor considers the reading normal, and enjoy being on the younger end of advancing age. I'm a soon-to-be-86 year old woman living a good life.

  • I never heard of age limits on dialysis. I anticipate that when I'm around 65-68, I will be around GFR 15. I will expect/demand whatever treatment is necessary to extend my life.

  • There is no age limit in the uk for dialysis at my husbands unit they have someone in their 90s & most others are over 65 including his friend of 70!

    & also you can be on the transplant list its generally down to other problems like my husband whos 61 & been on dialysis for 6 years who can't be listed at the moment so theres no need to worry you will be fine you won't need to fight for anything

  • Hi Bilbo,

    I would kill for a GFR of 58! Don't get too worried with the other things you listed. You won't have any noticeable symptoms (other than possibly anemia) until you're close to, or in, stage 4 (below 30). If you're in the US, I figure you're on Medicare. As a patient with CKD, they will pay for you to see a dietitian. Diet (knowing how to limit things like phosphorous and what foods/drinks contain it) can really, really help. Also, if you're not already, have your primary care physician refer you to a nephrologist. A nephrologist should see you (at your barely stage 3 GFR) every four months and have visits preceded by lab tests: including a comprehensive metabolic panel, urinalysis, phosphorous, potassium, and PTH, among others. You should also know that kidney function very often declines with age. You're basically at 100 when you're a child. Stay vigilant, take care of yourself (diet, exercise, sleep, annual flu shot and pneumonia vaccine) and be your own advocate. If you aren't assertive with your doctors, educate yourself and ask oodles of questions, no one will do it for you. Good luck.

  • Hi Crinkster

    Thanks for your sound advice. I already do most of the positive lifestyle things.

    I have always avoided the annual flu shot and pneumococcal vaccine after reading the well respected Cochrane Organisation reviews and meta analysis on their desirability. Instead I take 5000 ius Vitamin D3 intermittently throughout most of the year.

    Unfortunately we don't seem to have the ongoing battery of kidney tests in my UK health region, that you seem to have under US Medicare.

    So much for the NHS envy of the world that was portrayed by the tableau at the last Olympics!

    We have the lowest cancer survival rates in Europe.

    I feel compelled to highlight these things because of the propaganda.

  • One important thing to understand GFR. Six weeks ago, I had a number under 30. I have the ability, fortunately, to self-order and pay for a CMP ($17). My new GFR is 37. It's a range you should be shooting for, not a precise number (my maintenance range is 30-35). Ask your doctor what he/she expects your range to be before any freak-out. Good that you're going to a urologist. None of us are doctors and can't interpret all labs. Your kidney markers look good, from an amateur's point of view.

  • Hi Crinkster

    Obviously good that your latest GFR is above your maintenance range.

    My GP had not informed me but yesterday I found out after repeat questioning that my GFR was 55 in April 2015. This was put down to me having a bad chest infection. There was no notification of this to me, or subsequent follow up. Apparently when I received a blood test again in December 2015 due to gallbladder problems it was at or above 60. It may have been above 60, but for some reason the lab does not provide a precise figure above 60. It annoys me that some doctors in the UK do not feel it necessary to provide you with details of negative results. I am and always have been very much into preserving my health, but do not have the opportunity to make any dietary or other adjustments when they are so secretive.

    I also found out that a proteinuria ACR test has not been done, so I had to request that. I also asked for a repeat eGFR as the last one at 58 was two months ago. It would be useful to see if there has been any change. It is all very haphazard, and a bit of an uphill struggle with doctors. Pro-activity is non existent.

  • Hi I live in the USA and I am feeling the same about the doctors here too. I too had several test results and not informed of any changes. I also was not my own advocate as an increase in diuretics after contrast two days earlier caused an AKI! Now stage 3 CKD! So I do understand your struggle! Continue to be your own advocate and ask questions! Wishing you all the best!

  • Hi Grams 70

    Thanks for your comments.

    I am learning a new language with this urinary problem. I had to look it up but now know what an AKI is!

    From what I read they should be careful about giving you contrast when you have CKD. I am due for tests next week and have been a little concerned since I read this. Apparently contrast can push you downhill.

    It is a bit of a struggle to get doctors to interact properly with you. It seems a fairly widespread problem in this country and obviously yours too.

    Best wishes

  • Hi Bilbo

    The responses you have received are all wise ones. There is certainly no age limit for dialysis in the UK- it's more about whether it would improve your quality of life. However, with a GFR 50+, you certainly gave no need to worry too much. Go back to your doctor to discuss your concerns and ask if a referral is necessary. Good luck.

  • Hi Nicolala

    Thanks for your reassuring reply. It is not just the eGFR of 58 that worries me but the repeat microscopic blood and proteinuria, which can obviously be indicative of something serious in the urinary system.

    I will see a urology specialist next week.

  • I understand your concerns about proteinuria -this was the initial indicator of my FSGS. Do you have puffy ankles or are you retaining fluid anywhere? That is what happens when there isn't enough protein in your bloodstream. Do your blood tests show a low albumin? (Protein ). Good luck with the specialist. I hope you get the answers you need. X

  • That was a quick reply!

    I don't appear to have puffy ankles or fluid retention that I am aware of.

    My blood test as a result of extreme fatigue in November and before these kidney problems came to the fore (largely due to my own investigation) indicates Serum Albumin 41 g/L. As yet that does not mean much to me. Have you any insights with regard to that level?

    Serum Creatinine 109 umol/L, Serum Urea level 6.3 mmol/L. Serum Chloride. 106 mmol/L. Serum Potassium 4.6 mmol/L. Serum Sodium 142 mmol/L

    My Serum Alkaline Phosphatase is 50/UL, Serum ALT level 15 U/L, Serum Gama GT Level 14 U/L and Serum Total Bilirubin 22 umol/L. Do these latter ones indicate anything to you? I assume they are liver function tests.

    Any insights with regard to these levels are welcome.

  • The latter ones I am not familiar with. The others are all within the parameters of healthy range. Creatinine, potassium and urea are the clearest markers for kidney disease. An albumin of 30+ is healthy. Potassium should be 3.5-5.3. At this stage, from a renal point, nothing looks too alarming.

    It took 6 months and a collapse in hospital for me to see a renal consultant. My albumin was below 5 yet other bloods were fine. That was many years ago and things have changed. Your specialist will hopefully have more answers.

  • Many thanks for the reassuring replies to my post, and for sharing individual experiences.

    To answer a couple of questions. I am male and in the UK.

    I stumbled across this site because I was doing a Google trawl on some of my November blood test ratios to try and make sense of my symptoms. I was quite surprised and a bit disconcerted to find that I would be classified as having Stage 3a CKD, yet my results along with all the other ratios had been passed off as normal by my GP.

    I was also a bit upset because I have always looked after my health in terms of lifestyle, diet, and exercise etc. I have a healthy mixed diet, never smoked, only have the occasional glass of wine, and have a good BMI. I considered myself to be a fairly fit and healthy 70 year old. I expected to reap the dividend of continued good health in older years.

    I had prostate laser surgery for significant BPH 4 years ago. This year has been a bit problematic health wise. I had repeat gallbladder problems and eventually had it removed. Now I am having unexplained and worrying urinary symptoms I panicked a little because of the repeat pyuria, haematuria and proteinuria over the last 3 weeks without any pain. My immediate concern was kidney or bladder cancer. I have had to push for further investigation. In order to speed things up I am paying for a private urology consultation in two weeks time.

    In the interim I was trying to make sense of my blood tests which resulted from a feeling of presenting with absolute fatigue at the beginning of November 2016. The fatigue gradually went away after about three weeks. Unfortunately my Google search and discovery of the significance of GFR has added to my concerns.

    I have other anomalies in my blood tests that stood out. I would welcome any input from anyone who may have some insights. Apart from my GFR of 58. Haemoglobin estimation is over the max norm at 160 g/L. RBC is over the max norm at 5.4. Haematocrit - PVC is 0.49 l/l. Serum Ferrritin is 64.3 ug/L. This next one is not directly connected to the urinary system but serum Total Bilirubin is over the max norm at 22 umol/L.

    We keep being told that our NHS is the envy of the world. My experience concerning the health and end care of our respective parents and me and my wife's health treatment in the past few years does not at all support this. We find that problems are glossed over and dismissed at the GP stage. Tests are either not initiated or disregarded as with the GFR result. It is a constant push to get past the GP gatekeepers. We have to resort to self funding to get various tests or specialist consultations due to extensive waiting times. The situation is getting worse by the year. I believe that institutional ageism is endemic in the system.

  • To add to my earlier message, you are absolutely right to question GPS and ask for tests and clarification. This is your life. You have the right to ask for whatever you need to get to the bottom of this. I'm not sure about ageism-at the tender age of 46, it's unlikely I'll reach 70, having been on dialysis for 26 years already! I have only lasted this long because I question everything, take virtually no medication and know my condition well. Take care x

  • Nicolala

    Thanks again for your further reply, it brought me to a screeching halt. Given your experiences I feel a bit of a charlatan airing my worries.

    Can I assume that you have been waiting for a kidney transplant all these years?

    I sincerely wish you all the best xx

  • It's a scary business, whatever stage we are at.

    I had one transplant. I waited 16 years. It was a complete and utter disaster. I was in hospital for 4 months while Dr's pumped all sorts into me, trying to make it work properly. It never did and was removed. That was 9 years ago. I took myself off the transplant list. I don't want another. Dialysis and me get along just fine. I do it at home overnight. I totally self care and have a life. X

  • Hi Nicolala

    It was a pity that your long awaited transplant was not successful.

    Pleased to hear that you are coping with well with self care and home dialysis. All this stuff was completely unknown to me a few weeks ago. The end of 2015 and a great deal of 2016 was not a healthful year for me. We started off 2017 hoping that it would be a good year but our hopes were quite short lived. Nevertheless, others experiences on this site brings me down to earth.

    Wishing you a happy 2017 xx

  • My health authority doesn't refer to a nephrologist until late stage 3/early 4 (approx egfr 40 ish) and then they only see you every six months unless function decreases more rapidly. As others have said a gfr of 58 at your age is quite good as kidney function decreases the older we get. (I'm 49 and have 8%😟 Awaiting transplant). Has your gfr dropped more rapidly recently? The internet is a dangerous place as it creates more worry and doubt - I would trust your doctor - if they had any worries they should refer you to a nephrologist.

  • Hi Lilbill

    Thanks for your reply. Your experience puts my eGFR into perspective. I have read that kidney function decreases with age and the calculation involves subtracting 1 for every year over 40 from your age. I therefore expected to have an eGFR of 69. I will ask for a second test in due course and note that you should have fasted for 12 hours prior, and be well hydrated to optimise the test results.

    I believe that living with BPH for 15 years and an obstructive prostate probably damaged my kidneys. I also believe that the same urologist I saw over that period should have emphasised the need for surgery at an early stage.

    Wishing you all the best.

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