Somebody tell me why CKD stage 3a or 3b is no big deal.

Honestly I had stte 3A for decades and never paid any attention to it, and my doctor never mentioned it. In our 70's or even 60's it's pretty common. I think they should change it to "stage 1for >65 if eGFR is in the 50's!

My eGFR dropped from 55 to 36 (3B) a year ago and because I have lupus and high antibodies for scleroderma, I was sent to a nephrologist who sent me for heart, lung and kidney testing. Since then my creatinine based eGFR has fluctuated a lot. The sudden drop was the concern, not the actual value or stage. My Cystatin C, another type of eGFR, has been steadier and higher.

Hydration can cause lower scores. For me low blood pressure and muscle loss affect the creatinine based eGFR but not the Cystatin C, which has remained in the low 50's. Maybe you could hydrate and do a Cystatin C.

I have a friend with an eGFR of 18 and my mother was the same. We are not yet in dire condition with need for intervention apparently. I was told to hydrate and avoid NSAID's and maybe a dietician would help too.

My GFR dropped from 27 to 21 recently. There are many aspects to maintaining healthy kidneys. Low salt, no NSAIDS, exercise, good diet, etc. I now know infection is a kidney killer and is not talked about enough. I had COVID, Norovirus, and a raging UTI that came dangerously close to full on sepsis. This was 2 weeks ago. I did not even know I had a UTI. A ambulance ride to the ED showed the infection was quickly turning to sepsis. It can happen in 12-24 hours. That’s how fast kidney function declines unless you address infection. My Nephrologist at Mayo said sepsis is the thing that scares her the most for her kidney patients. I’m saying be aware of the signs. Antibiotics cleared up the infection, but my kidneys suffered and we’re waiting to see if they recover. If not, I’m going on the list.
Kidney function often declines over time. The huge drops are what Nephrologists are looking for. If you can remain somewhat stable meaning up or down a few GFR notches. Potassium levels, proteinuria, calcium levels…there are many markers that ebb and flow. Nephrologists often don’t explain the complicated dance with many aspects to kidney function. Ask questions! Get to know more than GFR numbers. And understand what painkillers and antibiotics you can tolerate. You are your best medical advocate.

The healthcare network is not into painkillers, so that's kinda out. I've had sepsis too, in 2017, not since. And right now, I'm recovering from yet another bout of Covid (with just finishing a course of Paxlovid). She didn't tell me a thing about what to eat or not eat, though I had learned not to load up on potassium, but only because it was way high with the bad results that got this front and center. I'm not sure what you mean by "on the list" except that sounds like a transplant list. I told her already I doubt I'd do such a thing. I already turned Orthopedic guys down back in 2014 about putting cadaver bone in my hips to make them recover. So, now I have avascular necrosis in the right hip. I had it in the left hip already way back then. There's so much wrong with my body, honestly, I think they're just waiting more for me to kick the bucket than helping me fix/correct what can be done.

@thenazareneshul As you have read, we need to advocate for our own health. Not only nephrologists, but many times other specialists beyond our primary care physicians, will seem to downplay a situation we consider important. In my opinion, getting to Stage 3A or B is a big deal, and we need to make it a priority.

My cousin suffered from long-term side effects of a cardiac medication from decades ago, which ultimately led to dialysis. At that time they had little clue what damage it could cause.

We want to look for trends, not necessarily a one time drop, unless there has been an infection or acute kidney injury [https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048] Decline in eGFR can be caused by uncontrolled diabetes or high blood pressure, diet manifestations, medication side effects, dehydration at time of testing. Our kidneys really are pretty sensitive to a lot of things, and we want to stay ahead of the curve to keep them as healthy as possible.

Switch to acetominophen [Tylenol] rather than ibuprophen or Aleve. Check medications you may be on to see if there is possible side effects of kidney concerns. If you have had a drop in eGFR and had any medical procedures that included contrast dye, your kidneys need time to clear that from your system, up to 2 weeks! As far as diet, minimize your sodium intake, watch protein intake, calcium/phosphorous/ potassium. Eat healthy for your lifestyle.

Remember, eGFR is only one value. As @mrainne mentioned, get to know what indicates a healthy kidney report.
Ginger

Now, see, this is why she, the nephrologist, isn't making sense. It turned out to be because of past labs also that it's fluctuating between CKD 3a and 3b. I'd already been taken off of all NSAIDs and then she's told me I can take the prescription for Meloxicam again. That was when my worst results came in! It's not like I don't want to take it, that was the best my pain has been for years. But I had stopped, because as I told her, "I'm not gonna just kill off my kidneys. I don't knowingly do things like that." So now, my daughter and I had allowed me 1 or 2 tabs a week (instead of 3 per day) as rescue meds. But I'm now to give Cymbalta a try, so if that helps the pain instead, that too is not an opioid. If it's safe for my kidneys. I do have high blood pressure. I have sinus tacycardia, and high cholesterol, and I'm obese from high Prednisone back in 2014-2015 for Polymyalgia Rheumatica. I've lost 30 obs of that but still have about 60 to go. And I take assorted other meds. I guess I'll just ask for a different nephrologist appt. Because I have to be able to ask about food restrictions, all she told me was not to eat large amounts of beef at any one sitting. I'd heard to cut the salt. That's really about it. Yet, it's good to find out my impression that I did not get good advice from her was right. I can move on with that, and her, behind me. I haven't had contrast in any imaging lately, so it's not that. Again, good to know. Thank you very much for the straight talk.

@thenazareneshul I am on my phone, but will answer completely Sunday to you. Will include some great links regarding foods and diet.

Don't feel you have to continue w a Dr you're not comfortable with. I changed nephrologists in the same practice. Like you, I have comorbidities along w kidney disease, that make my situation a complicated one.you likely have several specialists; ask them if they have worked with any nephrologist they can refer you to. Your whole medical team has to work together and be in communication with each other and you.
Ginger

I seem to have a primary doctor who I’m not sure is consistent. Tells me a few years ago I have fatty liver and CKD stage 3? Of course I freaked out ( he mostly diagnoses by the lab tests results). Tell me change my diet (see a nutritionist - but I can’t afford that & my insurance doesn’t cover that). He says do not take Tylenol or aspirin etc. I have serious osteoarthritis pain and nothing is prescribed for that. So I am trying to change my diet ( how many vegetables can I eat 😂 but I have always eaten them). MD says cut back on salt: I never salt my foods and rarely eat salty snacks. So I run into my Mom’s 90+year old cousin a few years ago, he says he has had CKD for years. I quit listening to my doctor because they don’t know everything

I had similar result.my markers place me in stage 3a. Doctor brushed it off. All my blood work up to this latest was ok no problems. I am 73. So I did some research and started exercising with 30 min morning walk and eating as recommended with research I did and drinking eight 16 oz gasses of water daily. I am just guessing but maybe the doctor wants to see test in three months to see where things are going. So much different information in websites and the few ebooks I purchased really do not know what to do. Did not tell my doc what I am doing will wait till Nov blood work to see if anything is working

The Tylenol comment by him is because of a fatty liver. The aspirin is about your kidneys, and it's all NSAIDs, not just aspirin. I was told, long ago, that it's alcohol AND Tylenol that are a danger (together) for livers. So, if you have major pain, I'd get a second opinion on that before cutting the Tylenol. I mean since you watch what you eat already. Too many doctor just assume a fatty liver means a lot of alcohol.

@thenazareneshul And here it is Sunday morning. Rough night last night, as we adopted two young rescue cats yesterday [one 6 months, one 4 months] They have an adjustment period to go through, that will definitely include how to interact with each other!

As for what to eat. Kidney.org is the website for the National Kidney Foundation. On the top tab you will find a drop-down that allows you to look at diet and nutrition. A lot of great information. Also, Renal Support Network rsnhope.org is a great site to go to. There are twice monthly support groups by Zoom, plus different groups that meet by Zoom [for example: diet/cooking, creativity, exercise] There is a lot of education to be had there. I have been with that group since 2015.

Moderate exercise, healthy eating [watch processed foods!], staying hydrated, reducing stress all can be to your benefit, not only with kidney disease but other health issues. We often laugh that when you need to look at what different diet plans to follow for different concerns, what is allowed on one list is not on the other!

Let me know if this is a help to you.
Ginger