What can you tell me about kidney disease?
November 10, 2022 5:38 PM Subscribe
Person is in their mid-sixties. Mildly mentally disabled, but has been living solo for decades. Why are their kidneys improving?
- Aug 2021 kidney GFR was 37 (which is stage 3 kidney disease = moderate).
On Sept 1, 2022, person was temporarily placed in a nursing home for reasons other than kidneys (is still there) and it is anticipated that they will remain there for several months. Kidneys are not receiving any type of treatment.
- Sept 7, 2022, GFR was 50 (which is stage 3A = moderate).
- Oct 19, 2022, GFR was 53 (which is stage 3A = moderate).
- Oct 25, 2022, GFR was 72 (which is stage 2 = mild).
Why is the GFR improving?
I don't know if the following has an affect:
Person has OCD and therefore drinks copious amounts of water. Person is not allowed to do so in nursing home. Person does not ever cook. Daily food is usually many cups of almond milk, many bowls of processed dry cereal, an orange, a 2.6 oz packet of tuna, carrot sticks, and a chocolate candy bar. In the nursing home, water is limited to normal amounts, and person is receiving a balanced diet.
- Aug 2021 kidney GFR was 37 (which is stage 3 kidney disease = moderate).
On Sept 1, 2022, person was temporarily placed in a nursing home for reasons other than kidneys (is still there) and it is anticipated that they will remain there for several months. Kidneys are not receiving any type of treatment.
- Sept 7, 2022, GFR was 50 (which is stage 3A = moderate).
- Oct 19, 2022, GFR was 53 (which is stage 3A = moderate).
- Oct 25, 2022, GFR was 72 (which is stage 2 = mild).
Why is the GFR improving?
I don't know if the following has an affect:
Person has OCD and therefore drinks copious amounts of water. Person is not allowed to do so in nursing home. Person does not ever cook. Daily food is usually many cups of almond milk, many bowls of processed dry cereal, an orange, a 2.6 oz packet of tuna, carrot sticks, and a chocolate candy bar. In the nursing home, water is limited to normal amounts, and person is receiving a balanced diet.
This was one of my search results: This study suggests an optimum range of 1–2 L/day water intake for CKD patients, which should be confirmed in other cohorts or clinical trials.
posted by aniola at 6:21 PM on November 10, 2022 [1 favorite]
posted by aniola at 6:21 PM on November 10, 2022 [1 favorite]
Other potential factors:
GFR can change based on blood pressure and its control. Bouts of diarrhea can worsen your GFR. When I had severe anemia, my GFR was worse by maybe .2 or .3, which makes a big difference. Even the timing of the blood tests can change your GFR result -- it can be worse if you've recently eaten, or if you've eaten cooked meats the night before the bloodwork.
posted by mochapickle at 6:27 PM on November 10, 2022 [2 favorites]
GFR can change based on blood pressure and its control. Bouts of diarrhea can worsen your GFR. When I had severe anemia, my GFR was worse by maybe .2 or .3, which makes a big difference. Even the timing of the blood tests can change your GFR result -- it can be worse if you've recently eaten, or if you've eaten cooked meats the night before the bloodwork.
posted by mochapickle at 6:27 PM on November 10, 2022 [2 favorites]
Sorry, my brain. My creatinine was worse by .2 or .3. My GFR dropped by several percent.
posted by mochapickle at 6:41 PM on November 10, 2022 [1 favorite]
posted by mochapickle at 6:41 PM on November 10, 2022 [1 favorite]
Not a nephrologist but… a GFR is a calculation (and not strictly speaking, a measurement). One thing that can happen is that as muscle mass decreases, a person may have a lower creatinine and thus a change in their EGFR.
posted by honeybee413 at 6:41 PM on November 10, 2022 [5 favorites]
posted by honeybee413 at 6:41 PM on November 10, 2022 [5 favorites]
The only changeable input into the GFR equation is serum creatinine (ie, amount of creatinine in your blood). (There are some other factors in the equation like your age, but those are things that won't change over the time period you're talking about.)
So look at the serum creatinine levels and there you will see the source of the differences in the eGFR levels.
One thing is, creatinine measurements vary by easily +/- 10%, or even up to 20%, based on nothing but random differences. I read on research paper that showed something like 10% variation from the same sample sent two different labs and such-like things.
So as a rule you don't get overexcited about one single creatinine (or eGFR) reading. You get 3 or 4 or 5 lab readings over a period of say 6 months and then average them.
So you are seeing an upward trend here but it is very possible that you are just seeing four randomly distributed values around a mean value, and they have (randomly!) happened to arrange themselves into an upwardly moving line, which they (randomly!) do some percentage of the time.
Another possibility is there was some acute kidney injury and the patient has gradually recovered from that over a few months. "Injury" doesn't necessarily mean that it went all the way to kidney failure - maybe it just went part of the way there. People can and do recover quite a bit from an acute injury of that sort.
Watching the creatinine & eGFR values over the next 6 months or so will very likely tell you the real story - they will either continue to circulate around a mean of, say 50 eGFR or perhaps they will level off around 70 or perhaps even continue moving upwards to 80, 90, 100, etc.
Other questions:
- Is there also diabetes, either Type 1 or 2? If so, the kidney injury is likely related to the diabetes, and getting control of the diabetes will help.
- Is there also an abnormally high level of urine protein (or an even better indicator, urine albumin)? CKD is defined as decreasing/low eGFR combined with abnormally high protein/albumin in the urine.
The protein in the urine is actually the best indication of the progression of CKD. Low protein indicates no or very, very little progression in loss of kidney function. Moderate or high (or very high) urine protein indicates ongoing progression of the CKD.
Also FYI eGFR naturally runs lower as a person ages. An eGFR of 70 or even 60 would not be abnormal at all for a person in their 60s - and not really something to become very concerned about unless it is accompanied by abnormally high protein in the urine (or other conditions that can damage kidneys over time, such as uncontrolled diabetes, uncontrolled high blood pressure, etc).
If you want to understand eGFR, kidney disease, etc - particularly the type seen as the natural result of aging or chronic conditions like Type 2 Diabetes - I cannot recommend the series of Youtube videos made by Dr Rosansky on "Dadvice TV". He goes over all the basics and helps a lot in understanding what labs, doctors, etc are telling you. Also he has a book that is not too expensive, is very good, and covers much of the same territory.
posted by flug at 1:18 AM on November 11, 2022 [3 favorites]
So look at the serum creatinine levels and there you will see the source of the differences in the eGFR levels.
One thing is, creatinine measurements vary by easily +/- 10%, or even up to 20%, based on nothing but random differences. I read on research paper that showed something like 10% variation from the same sample sent two different labs and such-like things.
So as a rule you don't get overexcited about one single creatinine (or eGFR) reading. You get 3 or 4 or 5 lab readings over a period of say 6 months and then average them.
So you are seeing an upward trend here but it is very possible that you are just seeing four randomly distributed values around a mean value, and they have (randomly!) happened to arrange themselves into an upwardly moving line, which they (randomly!) do some percentage of the time.
Another possibility is there was some acute kidney injury and the patient has gradually recovered from that over a few months. "Injury" doesn't necessarily mean that it went all the way to kidney failure - maybe it just went part of the way there. People can and do recover quite a bit from an acute injury of that sort.
Watching the creatinine & eGFR values over the next 6 months or so will very likely tell you the real story - they will either continue to circulate around a mean of, say 50 eGFR or perhaps they will level off around 70 or perhaps even continue moving upwards to 80, 90, 100, etc.
Other questions:
- Is there also diabetes, either Type 1 or 2? If so, the kidney injury is likely related to the diabetes, and getting control of the diabetes will help.
- Is there also an abnormally high level of urine protein (or an even better indicator, urine albumin)? CKD is defined as decreasing/low eGFR combined with abnormally high protein/albumin in the urine.
The protein in the urine is actually the best indication of the progression of CKD. Low protein indicates no or very, very little progression in loss of kidney function. Moderate or high (or very high) urine protein indicates ongoing progression of the CKD.
Also FYI eGFR naturally runs lower as a person ages. An eGFR of 70 or even 60 would not be abnormal at all for a person in their 60s - and not really something to become very concerned about unless it is accompanied by abnormally high protein in the urine (or other conditions that can damage kidneys over time, such as uncontrolled diabetes, uncontrolled high blood pressure, etc).
If you want to understand eGFR, kidney disease, etc - particularly the type seen as the natural result of aging or chronic conditions like Type 2 Diabetes - I cannot recommend the series of Youtube videos made by Dr Rosansky on "Dadvice TV". He goes over all the basics and helps a lot in understanding what labs, doctors, etc are telling you. Also he has a book that is not too expensive, is very good, and covers much of the same territory.
posted by flug at 1:18 AM on November 11, 2022 [3 favorites]
have they been put on blood pressure medication?
posted by chiquitita at 2:29 AM on November 11, 2022 [1 favorite]
posted by chiquitita at 2:29 AM on November 11, 2022 [1 favorite]
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Is the person receiving a normal balanced diet or a 'renal' specific diet? I'd conjecture that a nursing facility that is tracking someone's GFR would give the latter, which would provide additional help.
posted by Superilla at 5:57 PM on November 10, 2022 [4 favorites]