Liver or Kidney Problem??

Posted by tonto999 @tonto999, Aug 6, 2021

I'm a 61 y/o female. I recently had a second set of lab work done for ruling out problems with my liver. My results show alkaline phosphatase 153, Creatinine EGFR 50, Creatinine Serum 1.1, Ferritin 15.3. I don't really know what this means. Is it my kidneys or liver?? What could it be?

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@tonto999, I am happy to welcome you to Mayo Connect. We are a welcoming online community where patients and caregivers share their experiences, find support and exchange information with others. We are not qualified to interpret or to diagnose medical information.

I am a liver and kidney transplant recipient. From my own experience, I have learned that labs can change over time, and sometimes the doctor will be looking at the changes over time to learn about a condition. Or sometimes there is a particular number that they concentrate on. I have also learned that when my doctors were diagnosing my liver disease, they looked at my labs as a piece of the puzzle. It took other tests and scans along the way.

You have had a second set of labs done to rule out problems with your liver. Is this a follow-up from a recent lab?
Are you experiencing any symptoms that took you to see your doctor?

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I’d like to also extend my welcome to the Connect community along with @rosemarya. My recent history of a bone marrow transplant has me up close and personal with blood numbers.
The results you’ve posted for being 61 really don’t look that far out of whack. To this day my creatinine and Alkaline Phos are about the same level as yours. My doctors have very little concern over that at this point and I’m 67.
Your ferritin number appears in the normal range. That basically shows the amount of iron in your blood.
The eGFR is the flow rate of your urine through your kidneys. At your age, in a perfect world charts would want that at >60. Your number is 50 so that’s pretty flow-worthy. Just up your water intake to keep things flowing. Mine is around 42 right now because of some meds I’m taking.

My husband at 70 has a creatinine which has run from 1.1 to 1.2 for 10 years. It’s consistent and stable. With annual physicals his doctor feels he is in excellent health with no concern for that creatinine number. Doctors take into account the overall physical shape of a person as well as just one number.

Rosemary is so right that blood tests are more of a piece of the larger puzzle. There are more clues needed before you’ll get a definite answer.
Since your kidney numbers appear to be pretty normal, you feel your doctor is concentrating on your liver? What led him to the follow up?
Lab results which would be more value in showing liver damage or involvement would be a liver enzyme panel:
ALT alanine aminotransferase
AST (aspartate aminotransferase.
Bilirubin
Do you remember seeing these numbers on your CBC panel?

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@loribmt

I’d like to also extend my welcome to the Connect community along with @rosemarya. My recent history of a bone marrow transplant has me up close and personal with blood numbers.
The results you’ve posted for being 61 really don’t look that far out of whack. To this day my creatinine and Alkaline Phos are about the same level as yours. My doctors have very little concern over that at this point and I’m 67.
Your ferritin number appears in the normal range. That basically shows the amount of iron in your blood.
The eGFR is the flow rate of your urine through your kidneys. At your age, in a perfect world charts would want that at >60. Your number is 50 so that’s pretty flow-worthy. Just up your water intake to keep things flowing. Mine is around 42 right now because of some meds I’m taking.

My husband at 70 has a creatinine which has run from 1.1 to 1.2 for 10 years. It’s consistent and stable. With annual physicals his doctor feels he is in excellent health with no concern for that creatinine number. Doctors take into account the overall physical shape of a person as well as just one number.

Rosemary is so right that blood tests are more of a piece of the larger puzzle. There are more clues needed before you’ll get a definite answer.
Since your kidney numbers appear to be pretty normal, you feel your doctor is concentrating on your liver? What led him to the follow up?
Lab results which would be more value in showing liver damage or involvement would be a liver enzyme panel:
ALT alanine aminotransferase
AST (aspartate aminotransferase.
Bilirubin
Do you remember seeing these numbers on your CBC panel?

Jump to this post

Hi, Thank you for the welcome and information. I need all I can get! 🙂

I have an annual exam including routine blood work. This is the first time I've ever had abnormal results. Last year I skipped my labs due to COVID-19. Only the abnormal tests are below:

April: WBC 4.4 ALK Phos 153 C EGFR 56.
July: ALK Phos 180 Creat Serum 1.1 Creat EGFR 50 WBC 4.4.

july 29: Liver Ultrasound -revealed coarsened heterogeneous echotexture & size at upper limits of normal (15.9 cm). Hepatopedal flow in the portal vein. No gallbladder. Pancreas appears ok. Right kidney shows no evidence of hydronephrosis, shadowing renal calculi or suspicious mass. No ascites is appreciated in the visualized abdomen. No Murphy's sign. Possible underlying chronic liver disease.

Aug 4: Creat EGFR 50 Creat Serum 1.1 Ferritin 15.3 Alkaline Phos153

Bilirubin is normal. This is all I know. Does that help answer my question?

REPLY
@rosemarya

@tonto999, I am happy to welcome you to Mayo Connect. We are a welcoming online community where patients and caregivers share their experiences, find support and exchange information with others. We are not qualified to interpret or to diagnose medical information.

I am a liver and kidney transplant recipient. From my own experience, I have learned that labs can change over time, and sometimes the doctor will be looking at the changes over time to learn about a condition. Or sometimes there is a particular number that they concentrate on. I have also learned that when my doctors were diagnosing my liver disease, they looked at my labs as a piece of the puzzle. It took other tests and scans along the way.

You have had a second set of labs done to rule out problems with your liver. Is this a follow-up from a recent lab?
Are you experiencing any symptoms that took you to see your doctor?

Jump to this post

Hello! Happy to meet you. Congratulations on your transplant. Yes, lab results do change constantly. I've never had an abnormal lab result before so I'm a little nervous.

I did get 3 lab tests now and an ultrasound. I posted that information in a reply to Lori, Volunteer Mentor below. I didn't seek medical attention because of symptoms. I went in for my annual medical exam. I did not have one in 2020 because of COVID-19. Routine bloodwork came back abnormal. I don't know what other tests they will request next.

REPLY
@tonto999

Hi, Thank you for the welcome and information. I need all I can get! 🙂

I have an annual exam including routine blood work. This is the first time I've ever had abnormal results. Last year I skipped my labs due to COVID-19. Only the abnormal tests are below:

April: WBC 4.4 ALK Phos 153 C EGFR 56.
July: ALK Phos 180 Creat Serum 1.1 Creat EGFR 50 WBC 4.4.

july 29: Liver Ultrasound -revealed coarsened heterogeneous echotexture & size at upper limits of normal (15.9 cm). Hepatopedal flow in the portal vein. No gallbladder. Pancreas appears ok. Right kidney shows no evidence of hydronephrosis, shadowing renal calculi or suspicious mass. No ascites is appreciated in the visualized abdomen. No Murphy's sign. Possible underlying chronic liver disease.

Aug 4: Creat EGFR 50 Creat Serum 1.1 Ferritin 15.3 Alkaline Phos153

Bilirubin is normal. This is all I know. Does that help answer my question?

Jump to this post

Good morning! More clues revealed to the puzzle! Thank you. This helps put more pieces in place. I know it’s really intimidating seeing reports and not understanding what the heck they all mean.

I’ve gotten a crash course through immersion I guess you could say. For months I was having daily blood draws to watch all the bodily functions. With the help of my transplant team, my husband and I learned to read and understand all the numbers at a glance.
At one point I had an acute medical event which required immediate reaction. The med I was given worked for the critical issue but it had my ALP zooming up into the 700s. Fortunately I was in the hospital at the time and the doctors quickly got the liver damage under control. Our livers can be very resilient…

Looking at the past CBC results from April, July and August…all of your numbers are still not that far from norm.
The ALP (alk pho) at 183 was moving into a higher range but dropped back to 153 again. High “normal” for an adult is 140.
But because it is elevated from your historical normal, your doctor was prudent in making the call to have an ultrasound of your liver. Nice to see he/she is being proactive for your continued good health.

Looking at your liver ultrasound, a coarsened heterogeneous echo means the liver texture isn’t uniform. It’s not very specific. It doesn’t really tell you what’s wrong, only that something is different and merits further study. Fatty deposits, scarring from cirrhosis, hepatitis, etc., can cause the liver texture to change.

The remainder of the test is showing all normal results. Hepatopedal flow is the normal flow of blood into the liver, so that’s good. No issues with kidney, gallbladder, pancreas. No Murphy’s sign (checking for gall bladder issues) So your doctor is keying into possible liver involvement.

The next step might be a liver biopsy to get a sample of the tissue in question. That’s much easier than it sounds! I’ve had several and they are virtually painless and fairly quick.

Have you spoken with your doctor since the latest results on July 29th?

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Thank you for the explanation! You’re helping me be calm about this. I haven’t talked to my doctor yet. As of today, her nurse said all the test results haven’t come back yet. I’ll post when I find out.

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@tonto999

Thank you for the explanation! You’re helping me be calm about this. I haven’t talked to my doctor yet. As of today, her nurse said all the test results haven’t come back yet. I’ll post when I find out.

Jump to this post

You’re most welcome and I’m happy to help you remain calm. I’ve learned we really just can’t live in the world of what if’s…it will eat us alive. I swear we’re our own worst enemies sometimes with all the self-talk that fills our heads with needless worry. Hard to be human isn’t it? LOL.

You and your doctor are very proactive with your health. With your annual exams you’re able to spot any tiny change in your ‘body language’ which is so important in maintaining overall health. You’re a dream patient!

In the meantime, since those outstanding results are always in the back of the mind, what do you enjoy doing to keep distracted?

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@tonto999

Hello! Happy to meet you. Congratulations on your transplant. Yes, lab results do change constantly. I've never had an abnormal lab result before so I'm a little nervous.

I did get 3 lab tests now and an ultrasound. I posted that information in a reply to Lori, Volunteer Mentor below. I didn't seek medical attention because of symptoms. I went in for my annual medical exam. I did not have one in 2020 because of COVID-19. Routine bloodwork came back abnormal. I don't know what other tests they will request next.

Jump to this post

@tonto999, I can understand your confusion and concern. My liver disease was discovered when my PCP observed that my liver function labs were out of the normal range during my annual visit. He ordered repeat labs for me, just like your doctor has done for you. He also told me to take no over-counter meds, or have no alcohol, and he double checked the BP and cholesterol med that he had prescribed for me. To my disappointment and fear, my labs did not change. So he referred me to a gastroenterologist (GI) for further investigation. I remember that he began to order labs specific to test for a cause of my elevated enzymes. I also had ultra sound and biopsy.
There are many issues that can result in elevated liver enzymes. I am happy that you are under the eye of an observant doctor.
I want to encourage you to begin a list of all your questions, so that you can have a meaningful consult with the doctor.

REPLY
@rosemarya

@tonto999, I can understand your confusion and concern. My liver disease was discovered when my PCP observed that my liver function labs were out of the normal range during my annual visit. He ordered repeat labs for me, just like your doctor has done for you. He also told me to take no over-counter meds, or have no alcohol, and he double checked the BP and cholesterol med that he had prescribed for me. To my disappointment and fear, my labs did not change. So he referred me to a gastroenterologist (GI) for further investigation. I remember that he began to order labs specific to test for a cause of my elevated enzymes. I also had ultra sound and biopsy.
There are many issues that can result in elevated liver enzymes. I am happy that you are under the eye of an observant doctor.
I want to encourage you to begin a list of all your questions, so that you can have a meaningful consult with the doctor.

Jump to this post

Thank you so much! I appreciate your time. I guess I’ll have to wait and see. I will post again once I have new information.

REPLY
@rosemarya

@tonto999, I can understand your confusion and concern. My liver disease was discovered when my PCP observed that my liver function labs were out of the normal range during my annual visit. He ordered repeat labs for me, just like your doctor has done for you. He also told me to take no over-counter meds, or have no alcohol, and he double checked the BP and cholesterol med that he had prescribed for me. To my disappointment and fear, my labs did not change. So he referred me to a gastroenterologist (GI) for further investigation. I remember that he began to order labs specific to test for a cause of my elevated enzymes. I also had ultra sound and biopsy.
There are many issues that can result in elevated liver enzymes. I am happy that you are under the eye of an observant doctor.
I want to encourage you to begin a list of all your questions, so that you can have a meaningful consult with the doctor.

Jump to this post

Hi Rosemary,
I got news from my Dr..She’s sending me to a gastro Dr for more tests. What happened when you went to the gastro Dr? What was the outcome from your gastro tests? Dr suggested taking iron supplements for low iron. She’ll see me back after gastro appointment.
Thanks again.

REPLY
@tonto999

Hi Rosemary,
I got news from my Dr..She’s sending me to a gastro Dr for more tests. What happened when you went to the gastro Dr? What was the outcome from your gastro tests? Dr suggested taking iron supplements for low iron. She’ll see me back after gastro appointment.
Thanks again.

Jump to this post

@tonto999 I am happy to hear that you are going to be seeing a GI. You will be amazed at the vast amount of information that he will bring into your care.
My GI started with a general exam and with more labs and tests as needed.
Each test had a specific purpose. The goal is to find a diagnosis so that a treatment plan can be implemented.
My GI ordered an ongoing series of labs as he was searching for a diagnosis. It seemed to take forever. I learned that I had a rare condition, and he eventually sent me to a liver specialist for my diagnosis. I hope that in your case, you will have an easier diagnosis and that it will come more quickly.
As an FYI – my liver was the culprit, or rather my bile ducts. My eventual cirrhosis caused my kidney failure.

When do you have your appointment with the GI?

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Rosemary, I don't have an appointment yet. I am a veteran of the Air Force and go to the VA for treatment. They schedule my appointments. I'm ready to get this over! 🙂

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