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Elevated CREATININE, EGFR levels. KIDNEY FAILURE?

Resolved Question:

Whie male age 60 200 lbs

Last year my creatinine level was .89 with a egfr of 94.
This year it was 1.05 with a egfr of 58.
Using all the on line calculators Davita etc I get 77 using Creatinine of 1.05 age 60.

58 is stage three ckd. Should I be worried about kidney failure? or is the Egfr a mistake.


Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,
Thank You for your query at DoctorSpring.com
There has been a drastic drop in the eGFR and that does not seem possible in a span of one year.
What are your symptoms? Any pedal edema, excessive urination? Was it a part of a routine test?
I will advise you get it rechecked, because with such low eGFR even creatinine is supposed to be elevated, but creat is in normal range, and that shows that the kidney is healthy.
Regards.


Patient replied :

I do not have any pedal edema, no protein in urine, no fatigue. I ride 5 miles a day on bike and work with light weights 3 times weekly. The labs were for my annual physical. Everything is always normal. How could the Kidney's deteriorate so rapidly?. When you calculate the GFR on line it is 78. The lab says 58. Numbers I used were Creatinine 1.05, age 60, 200 lbs, white male. When you plug in the numbers from last year the GFR comes to 94. That what it as on the labs. How can there be a 20 point discrepency from Davita's calculator and the Lab. Also no elevation in BUN. BUN 10, albumin 4.5. Hemocrit and memoglobin at the high range of normal. All labs are excellent.


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,
Thank you for the follow up.
Your calculations are spot on. There is no way your eGFR can be so low. There was some mistake with the lab values. This is supported by the simple scientific evidence that your creatinine is in normal range, the first parameter that goes haywire in any level of CKD is creatinine. BUN being normal supports the fact that your kidney is healthy.
Also last year the creat value was 0.89 and this year it is 1.05. This variation can occur even on a daily basis, depending on fluid intake, dehydration, e.t.c
So overall assessing your reports i will say your kidney is perfectly normal. There is no cause to worry.
If you want for your own satisfaction, you can get the eGFR repeated, and the values will come back in normal range. This 58 seems like a mistake.
Regards.


Patient replied :

One last question. The EGFR calculation is universal MDRD. As you explained it is more than likely a mistake. If I noticed the issue with the test sholdn't my physician have quesitoned it?


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Yes you can review that with your physician.
See as a doctor, i will be worried if your creatinine was elevated. Because any kidney pathology, creatinne is the first marker to get deranged. It has no other mode of excretion, any kidney pathology will immediately shoot up the creatinine values.
eGFR in that range indicates moderate CKD, which means you will have symptoms such as puffiness of face, pedal edema, difficulty in breathing, e.t.c
I am sure your physician also did not give any importance to your eGFR seeing other values. IF you had signs of moderate CKD he would have advised treatment right away.
Since you're so healthy there is no way your eGFR can be that low.
But i will advise you to repeat the eGFR test again and then you can get back to me.
Regards.


Patient replied :

One last question. Is there any significance to a low BUN to Creatine level of 10/1. BUN 10 Creatine 1.05. On line says it could be caused by liver failure


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

Hello,
The normal BUN/Creatinine ratio varies between 10:1 to 20:1.
Yours is 10:1, so there is nothing to worry.
Lower than that ( 5:1 or 4:1 ) signify advanced liver disease, like cirrhosis, low protein c levels, e.t.c
Hope this was helpful,
Regards.


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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