Understanding GFR and kidney disease: What's normal?

Posted by bugsowen @bugsowen, Sep 23, 2020

Just officially diagnosed ckd stage 3 June this year but doc has been monitoring. December 2018 GFR 56. June 2020 GFR 48. Was not given any thing other than water daily excersise and reduce alcohol. After research on ckd it looks very serious. Called doc back few days after appt for more info. Came with plant based low protein diet. Ordered some cookbooks and cobbled together what I called kidney diet. Follow up blood work now showed GFR 60!!! But monocytes and mch are high. Next appt is 10/2/20. Is this increase in GFR normal and will it last? BTW I am 66 will be 67 in c
December

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@lorrie11963

I was wondering if your GFR can go up from 78. My Creatine is 0.8 was that last time with GFR of 105. I’m all confused

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As we age, typically eGFR goes down. More power ţo you should it go exceedingly high. It sounds like you are keeping both diabetes and kidney function in check. As I understand, diabetes levels are determined by A1C which you did not mention. The most important issue to remember, I believe, is the "trend" of eGFR. With you next labs, look at your history of eGFR, and then make a determination. Hydration at lab test time, also plays an important part of your estimated GFR.

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@lorrie11963

I was wondering if your GFR can go up from 78. My Creatine is 0.8 was that last time with GFR of 105. I’m all confused

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Hi @lorrie11963, I moved your question about Glomerular Filtration Rate (GFR) to this existing discussion in the Kidney & Bladder group:
- Understanding GFR and kidney disease: What's normal?: https://connect.mayoclinic.org/discussion/gfr/

I did this so you can read the previous helpful posts and connect with others talking about GFR.

Since you posted in the Diabetes & Endocrine group, @collegeprof offers some helpful tips about monitoring trends lines for both eGFR and A1C.

Are you dealing with both diabetes and kidney issues?

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@colleenyoung

@bugsowen, as you likely know, Glomerular Filtration Rate (GFR) tells how much kidney function you have. It may be estimated from your blood level of creatinine. Living with kidney disease means patients become professional GFR readers. I'd like to bring @kamama94 @gingerw @trishanna and @fiesty76 and @jolinda into this discussion to talk about GFR and interpreting lab results with you.

Bugs, How are you doing with adapting your diet?

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I agree we become GFR readers because those numbers are easily understood. My last post was on acceptance and being positive. Now, I am asking for your input. (1) Are strokes more common for dialysis patients than for transplant patients? (2) If the GFR falls below 15, say to 10, does that change the direction of care from dialysis to transplant? My husband is the patient, and I am the not-so-patient (LOL). He has always taken a "pills in a bottle" approach, while I am a holistic-approach person. His nephrologist scheduled him for pre-dialysis port/line appointments, but now has contacted Mayo-PHX for a transplant evaluation. Both options are open. (3) Would the lower GFR prompt the second approach?
It is difficult for me to watch this scenario play-out, especially since my doctors are evaluating me for chronic liver disease of unknown origin. Acceptance and positivity!
Sarah.

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@sarah82

I agree we become GFR readers because those numbers are easily understood. My last post was on acceptance and being positive. Now, I am asking for your input. (1) Are strokes more common for dialysis patients than for transplant patients? (2) If the GFR falls below 15, say to 10, does that change the direction of care from dialysis to transplant? My husband is the patient, and I am the not-so-patient (LOL). He has always taken a "pills in a bottle" approach, while I am a holistic-approach person. His nephrologist scheduled him for pre-dialysis port/line appointments, but now has contacted Mayo-PHX for a transplant evaluation. Both options are open. (3) Would the lower GFR prompt the second approach?
It is difficult for me to watch this scenario play-out, especially since my doctors are evaluating me for chronic liver disease of unknown origin. Acceptance and positivity!
Sarah.

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@sarah82 Kidney disease, as you know, can have several different base causes. Uncontrolled [and sometimes even controlled!] high blood pressure, and diabetes appear to be the leading causes of chronic kidney disease. Other factors can be genetic [polycystic kidney disease], lifestyle, or effects of long-term use of certain medications. Diabetes and high blood pressure in and of themselves can contribute to stroke events. There is very real truth that transplant patients work hard to keep their new kidney working optimally, and their lifestyle may trend much healthier than before. So, I cannot say if dialysis or transplant people have more strokes. When I was researching this, somewhere I read that the toxins that can build up in our system can lead to greater risk of stroke.

Deciding between dialysis and/or transplant is an important thing. Most patients go on dialysis for a time, unless they have a living donor and can do a pre-emptive transplant. Transplant evaluation can be a lengthy procedure as they look at everything. Typically, at eGFR of 20, doctors may start talking about dialysis, and the "what to do when we get there". Some start at eGFR of 10, while others start at a higher number. For me, I started at eGFR of 14, because I am also an active cancer patient undergoing chemo, and frankly I was just too worn down.

Does this help you at all, and answer your questions? Please let me know!
Ginger

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@gingerw

@sarah82 Kidney disease, as you know, can have several different base causes. Uncontrolled [and sometimes even controlled!] high blood pressure, and diabetes appear to be the leading causes of chronic kidney disease. Other factors can be genetic [polycystic kidney disease], lifestyle, or effects of long-term use of certain medications. Diabetes and high blood pressure in and of themselves can contribute to stroke events. There is very real truth that transplant patients work hard to keep their new kidney working optimally, and their lifestyle may trend much healthier than before. So, I cannot say if dialysis or transplant people have more strokes. When I was researching this, somewhere I read that the toxins that can build up in our system can lead to greater risk of stroke.

Deciding between dialysis and/or transplant is an important thing. Most patients go on dialysis for a time, unless they have a living donor and can do a pre-emptive transplant. Transplant evaluation can be a lengthy procedure as they look at everything. Typically, at eGFR of 20, doctors may start talking about dialysis, and the "what to do when we get there". Some start at eGFR of 10, while others start at a higher number. For me, I started at eGFR of 14, because I am also an active cancer patient undergoing chemo, and frankly I was just too worn down.

Does this help you at all, and answer your questions? Please let me know!
Ginger

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Thanks, Ginger. Yes, your response helps me better understand more about the point in the GFR readings where decisions are made to continue onto the next stage in the management of the kidney disease. And, each person is different and their situation may have different elements to consider. I also understand your comment of feeling "too worn down." Perhaps the typical patient is so tired and depressed they do not communicate their feelings, and may not want to spend the required energy researching for answers.
Sarah.

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I am 87 and live alone and early in the spring I was told my eGFR was 38 it scared me. I started reading about kidney disease , I joined on line support groups to learn more and I decided that I could still try to do something about it. I bought walking shoes and started to walk most days, I started to exercise which I did very little of and I started to read labels which I never did before.. I also watch what and how much I eat. Yesterday I got the results Of my latest blood test and my EGFR is now 48. I never thought I personally could personally make a difference in my kidney disease but I proved myself wrong, We can make a difference .

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@eva1930

I am 87 and live alone and early in the spring I was told my eGFR was 38 it scared me. I started reading about kidney disease , I joined on line support groups to learn more and I decided that I could still try to do something about it. I bought walking shoes and started to walk most days, I started to exercise which I did very little of and I started to read labels which I never did before.. I also watch what and how much I eat. Yesterday I got the results Of my latest blood test and my EGFR is now 48. I never thought I personally could personally make a difference in my kidney disease but I proved myself wrong, We can make a difference .

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Good for you!

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@sarah82

I agree we become GFR readers because those numbers are easily understood. My last post was on acceptance and being positive. Now, I am asking for your input. (1) Are strokes more common for dialysis patients than for transplant patients? (2) If the GFR falls below 15, say to 10, does that change the direction of care from dialysis to transplant? My husband is the patient, and I am the not-so-patient (LOL). He has always taken a "pills in a bottle" approach, while I am a holistic-approach person. His nephrologist scheduled him for pre-dialysis port/line appointments, but now has contacted Mayo-PHX for a transplant evaluation. Both options are open. (3) Would the lower GFR prompt the second approach?
It is difficult for me to watch this scenario play-out, especially since my doctors are evaluating me for chronic liver disease of unknown origin. Acceptance and positivity!
Sarah.

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"My husband is the patient, and I am the not-so-patient (LOL)." LOVE, LOVE, LOVE THIS AND GOING TO START USING IT MYSELF!

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66 GFR is very good, stage 2; drink at least 64 ounces of water daily, cut out all other drinks like sodas, juices, which are not necessary. Keep on that diet and you may just go back to stage 1. good luck. You are in a very good place. I am 95 and have been in stage 3 for many years.

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@fiesty76

@bugsowen, My first indication of kidney disease was from a scan report ordered by my primary doc (pcp) for something else and mailed to me by the specialist reading the scan. I immediately called for an appt with pcp to ask for a referral to a nephrologist. My pcp hadn't mentioned that my egfr scores had been running lower than normal for some time. Only learned that I was stage 3 ckd at first visit with nephrologist who'd used scan results to tell me of my diagnosis. Have learned since from other ckd patients that many pcp's don't consider ckd worth discussing until a patient reaches stage 4.

It then took 2 requests to pcp and 2 requests to nephrologist to get referral to the dietitian. That persistence paid big dividends for me because I'd also been diagnosed with prediabetes and trying to come up with a diet plan for both was time consuming and nerve wracking. Modifying my diet with help from dietitian, learning how to read lab reports and make needed adjustments and learning from other ckd patients on this and another patient site are the three best things that have happened for me with my ckd.

Had I not asked for the nephrologist referral and persisted in requesting the dietitian referral, I am certain that I wouldn't have learned of the stage 3 diagnosis and that my ckd labs would not have shown the improvement they have. After three appts with the nephrologist, I will be changing to another nephrologist because other than telling me at the first visit to stop NSAIDS and take Tylenol instead for over-the-counter pain relief, she has provided almost no instruction on how to better maintain my kidney function. Becoming informed through research online from reputable sites like Mayo and NKF and membership in the patient groups has helped me become a much more proactive patient advocate for this serious health condition. Wishing you the best and hope you'll let us know how your next doc visit goes.

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I understand your troubles in finding results of CKD. Many doctors do not tell the patient at all. For 18 years 3 doctors knew I had stage 3 CKD, did not bother to tell me; I found I am in stage 3a since I moved to NC. I sent for my records & paid for 18 years of testing and every page said CKD stage 3. When I called my last Dr. in Ohio he said he did not know about it. Which means one thing, he ordered tests and did not bother to read them. All 3 doctors,
I mean; the other 2 would not talk to me. I am glad your persistence gave you results and help. Good luck, I am 95 as of Oct. 27 this year. And by the way: no pain killers work for me any more, so I am glad I have not much pain.

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