Type 1 Kidneys/ACR

[victry77]

Hi, I have received a letter today for a follow up appt from my recent annual review last month. The appt is for September and it is discuss my increased ACR. Wondered if anyone experienced with kidney issues could offer any input?

Background
- Female, UK, non-smoker/drinker.
- Dx Type aged 30 (just over 9yrs ago).
- Naturally very slim, weight never goes beyond 56kg.
- Cholesterol/HDL/LDL/Trigs always within normal range.
- BP always low-mid end of normal range.
- A1c has consistently been in the 40's for as long as I can think back. Last three results going back to 2015 have been 46, 41 and most recently 44.

Now, I've had to cast my mind back, but I had a couple of consecutive reviews in the past (likely between 2011-14) where I was required to repeat my urine sample due to slightly increased protein. I made sure I was very well hydrated on the repeat tests and they came back fine.

So here are the results of my last three lots of tests:

2015 - ACR: 4.6mg/mmol
- eGFR: 82ml/min
- Creatinine: 70umol/L

2016 - ACR: 2.1mg/mmol
- eGFR: 79ml/min
- Creatinine: 72umol/L

2017 - ACR: 3.8mg/mmol
- eGFR: 86ml/min
- Creatinine: 66umol/L

So, I have had fluctuating ACRS and slightly decreased eGFRs. I don't actually understand the creatinine as I keep coming across different range values online.

So, my questions are; is there anything that particularly leaps out regarding my values? Anything especially bad or good or how they read as a whole? Especially considering my normal BP/Cholesterol.

Secondly, I assume this follow-up appt is to discuss possible medication. Now, the consultant's report in 2016 acknowledged the fluctuating ACR and mentioned the possible use if ACEI's but stated that given my low BP it was doubtful I could cope with even a small amount of this medication. So, what happens in this instance? Are there any alternatives considering kidney problems seem so tied up with hypertension?

Any advice gratefully received.

 

[Bluetit1802]

Is the creatinine from urine or blood? It makes a difference.

 

[victry77]

Ah, I've no idea, I'm afraid. It's just the results from my blood tests and urine sample.

ETA - OK, I think it's blood. Just found a reference table for blood tests related to kidneys and it gives a range using the same measurements of umol/l

 

[Bluetit1802]

Ah, I've no idea, I'm afraid. It's just the results from my blood tests and urine sample.

ETA - OK, I think it's blood. Just found a reference table for blood tests related to kidneys and it gives a range using the same measurements of umol/l

It would help you to get a print out of your results so you would know for definite. If it is blood, your creatinine levels are all normal (46 to 92). and eGFR should be over 90. However, they moved the goalposts on eGFR not that long ago. It used to be over 60. When calculating the eGFR they incorporate your age, so the older you get the more likely you are to have a lower number.
The ACR should be under 2.3 and this is a urine test, not a blood test (as far as my own results say).

Other than that I can't help you. @pleinster knows about kidneys so I've tagged him.

 

[himtoo]

hi there !!
no idea myself but am tagging the lovely @Tanny35 who does know a lot about kidney issues and is a lovely person.

just a hug [hug] to finish .

 

[victry77]

Bluetit, this is a printout of the consultant's report sent to my doctor. I'm not sure I can get my hands on anything else. It just says creatinine. Thanks for the response nonetheless.

 

[Bluetit1802]

Bluetit, this is a printout of the consultant's report sent to my doctor. I'm not sure I can get my hands on anything else. It just says creatinine. Thanks for the response nonetheless.

Hopefully one of our kidney aficionados will come along to help.

 

[pleinster]

Hi, I have received a letter today for a follow up appt from my recent annual review last month. The appt is for September and it is discuss my increased ACR. Wondered if anyone experienced with kidney issues could offer any input?

Background
- Female, UK, non-smoker/drinker.
- Dx Type aged 30 (just over 9yrs ago).
- Naturally very slim, weight never goes beyond 56kg.
- Cholesterol/HDL/LDL/Trigs always within normal range.
- BP always low-mid end of normal range.
- A1c has consistently been in the 40's for as long as I can think back. Last three results going back to 2015 have been 46, 41 and most recently 44.

Now, I've had to cast my mind back, but I had a couple of consecutive reviews in the past (likely between 2011-14) where I was required to repeat my urine sample due to slightly increased protein. I made sure I was very well hydrated on the repeat tests and they came back fine.

So here are the results of my last three lots of tests:

2015 - ACR: 4.6mg/mmol
- eGFR: 82ml/min
- Creatinine: 70umol/L

2016 - ACR: 2.1mg/mmol
- eGFR: 79ml/min
- Creatinine: 72umol/L

2017 - ACR: 3.8mg/mmol
- eGFR: 86ml/min
- Creatinine: 66umol/L

So, I have had fluctuating ACRS and slightly decreased eGFRs. I don't actually understand the creatinine as I keep coming across different range values online.

So, my questions are; is there anything that particularly leaps out regarding my values? Anything especially bad or good or how they read as a whole? Especially considering my normal BP/Cholesterol.

Secondly, I assume this follow-up appt is to discuss possible medication. Now, the consultant's report in 2016 acknowledged the fluctuating ACR and mentioned the possible use if ACEI's but stated that given my low BP it was doubtful I could cope with even a small amount of this medication. So, what happens in this instance? Are there any alternatives considering kidney problems seem so tied up with hypertension?

Any advice gratefully received.

Hi. I was tagged by @Bluetit1802...because I was born with kidney disease and have been monitored since diagnosis at 17; I am now 55 and had a successful transplant over two years ago. First up - your eGFR is not just ok it's very good. I am not sure where the idea of it needs to be 90% comes from. I see renal specialists regularly and have all kinds of blood tests done (yesterday as it happens)...I have always been told, that anything over 60 is in the normal range. None of my current doctors has an average kidney function of over 80%. My current level is 45% and I have only one functional kidney (and 2 redundant ones still inside). My function dropped gradually over the decades until it was only 8% the day of my operation. I had no symptoms other than high blood pressure when it was a slow as 20%. I know for certain that I can function with no difficulty at all on 45% for the rest of my life if the new organ doesn't reject. anything above 70% is don't even concern yourself with it territory...seriously. Further, even eGFR is not the best guide to the health of the kidney...too many other factors contribute. Despite some expressed views on very general sites, nor is ACR. The real marker which renal specialists rely on if the creatinine level...and even that is effected by what you have eaten that day. A large increase in serum (ie. blood) creatinine is the concern. For your information, with ACR (the ratio for how much of the protein, Albumin, in the blood is leaking into the urine) anything less than 3.5 is completely normal. Levels above 4 can...(ie. CAN) indicate early signs of renal disease (if this is backed up by evidence in the blood creatinine level) but your 3.8 is nothing; an ACR of over 30 is requires to be classed as proteinuria (protein in the urine) and effective meds are available. What "leaps out" about your creatinine levels is that they are excellent. 60-120mmols/l is normal unless you are a tiny wee person (where less than 60 would be fine). My current serum creatinine level at 55 with one small kidney is around 155mmols/l); it was 800 on the day of my operation. Note - my blood creatinine levels have always been expressed in mmols per litre and I have never seen it recorded as ummols but, going by your very normal levels, it is undoubtedly the same thing. Your levels are nowhere near a problem. Fluctuation is not minor change such as 5-10mmols...it is increase or decrease maybe 20-30mmols and more before it is of any significance (and even then such changes are only significant if are part of a pattern like this). My creatinine levels can jump about a bit but I have about 155 as a baseline at the moment. In brief (which I am not good at..) all your levels are pretty normal. Stop worrying right now.

 

[pleinster]

By the way, sorry to not post sooner; I had great difficulty getting onto the site in the wee small hours..and was kicked off nearly two thirds of the way through my reply. I hope it helps relax you, @victry77.

 

[victry77]

Thank you very much for you reply Pleinster. I really appreciate your time and sharing of knowledge

I guess I was concerned as my clinic have made me a follow up appt to "discuss" this issue. So, this made me think that some plan of action needed to be put in place and that medication was going to be discussed. It was noted on my report from last year, too.

You've given me a good basic understanding of how the numbers work so I feel far more informed now and less worried I've got kidney damage, so thank you.

If they start talking about meds, I think I would be more inclined to leave it to be monitored (if that's what they feel I should be doing).

xx

 

[Bluetit1802]

I just read this earlier today and thought of you. Recommendations from NICE
https://www.diabetes.co.uk/downloads/guides/diabetes-health-guidelines.pdf

Kidney guidelines
Kidney function guidelines for diabetic patients are as follows:  Albumin/creatinine ratio: less than or equal to 2.5 mg/mmol (men) or 3.5 mg/mmol (women) (Urine test)

 

[paulliljeros]

@pleinster is absolutely right, and the only thing I would add, is that no-ones egfr is 100, simply because a) it is an estimated value, and secondly, the kidneys never work at 100% efficiency. It's worth noting that maintaining lower BGs and lower BP are 2 ways to protect your kidneys.
The following 2 info pages are the explanations of the measurements if you are interested.
Creatinine: http://www.rixg.org/results/creatinine.html
eGFR: http://www.rixg.org/results/egfr.html

 

[pleinster]

@pleinster is absolutely right, and the only thing I would add, is that no-ones egfr is 100, simply because a) it is an estimated value, and secondly, the kidneys never work at 100% efficiency. It's worth noting that maintaining lower BGs and lower BP are 2 ways to protect your kidneys.
The following 2 info pages are the explanations of the measurements if you are interested.
Creatinine: http://www.rixg.org/results/creatinine.html
eGFR: http://www.rixg.org/results/egfr.html

Hi. Just wanted to wish you all the best with your SPK transplant; I hope it is soon and very successful.

 

[paulliljeros]

Hi. Just wanted to wish you all the best with your SPK transplant; I hope it is soon and very successful.

Thank you very much ... As I'm sure you're aware, it gets frustrating waiting for "that" phone call ... but I'm 12 months in now, so hoping it is getting close.

 

[pleinster]

Thank you very much ... As I'm sure you're aware, it gets frustrating waiting for "that" phone call ... but I'm 12 months in now, so hoping it is getting close.

I was extremely fortunate, Paul, in managing to "steal" one from my sister just as my kidney function got to the dialysis stage. I was on the list at 15% function and had prepared for four hours three days a week on the machine and was due to have line out in, when she changed the whole game. The kidney was as good a match as is possible. The operation went very well and I was back home in a week. Initially, my eGFR was 60% and my creatinine was 101. I have had small complications... infections... diabetes from the @;(8&n steroids...and I am now been treated for BK virus in the graft. Still, three biopsies have shown there is no trace of rejection. I know I've been extremely fortunate to have had a live donor. I hope it all goes smoothly for you once you get "that call". Keep us posted, mate. By the way, the care I received in Edinburgh was amazing..from surgeon to junior doctor, from nurse to care assistant. After care treatment and the way they manage your med sand your levels post transplant is greatly changed from when my mother had her transplant back in the 80s. Take care.

Paul