eGFR history and latest test results

pleinster

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@pleinster . Your point about creatinine levels being raised due to protein (even a bit of meat) is interesting.

Whilst my kidney functions have always been excellent ( eGFR and creatinine) I have had 2 tests since diagnosis when the creatinine levels were higher than usual for me - and these tests are the only two I've had that were not fasting and done in the afternoon, so presumably this was due to what I had eaten for breakfast and lunch. Every other test (and there have been many) have been fasting with the creatinine levels a lot lower.

Hi. I watched my creatinine level increase from a fairly normalish 110-20 up through the 200s, up, up and up over the decades up as far as 670 the day of my transplant. There was nothing I could do to slow it...but blood pressure meds had had some effect otherwise it would have reached critical stage earlier. I didn't have any symptoms as such other than high BP until maybe the last two years before transplant. I did get a bit anxious as the high levels were pretty bad in that period and was preparing for dialysis (my mum had been/still on that for so so long) and a long time on the transplant waiting list until my sister offered me a kidney. In all that time, I knew that my readings could jump a bit if I wasn't drinking enough fluid or if I had eaten maybe steak the night before. In fact, as a couple of very good renal specialists told me, the level could jump a fair wee bit (say from 410-430) purely if I had eaten a few sausages and not had enough to drink the day before (depending on the quality of the sausage !). It's sensitive. I remember getting into the habit of drinking a few cups of water in the clinic before blood tests to keep it down! Pathetic, I know. I always found it difficult to drink a lot of water until I had my transplant and was told to drink around 3 litres a day. The smallest amount of diluted orange (Robinsons) made it just about do-able. it is worth noting that other meds can also increase creatinine levels (and obviously diabetes isn't exactly renal friendly).If anyone is concerned about such levels, I suggest that, as well as regular checks, god fluid intake and less red meat will help a little but not if its just what you do the day before a test ! ;) These days, I drink around 2 litres a day, I take my meds and I keep my fingers crossed my creatinine will stay where it is (between 140 and 155) but a virus in the kidney is not helping it get any lower. I'm sure your own slightly elevated levels will indeed be down to food/drink before a test, particularly if other tests have been excellent and you are not talking about a figure above 150.
 

pleinster

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Hi @pleinster .Thankyou for your reassuring reply.Im beginning to understand the science of it better.I had several IVP tests after my son was born and continued to be checked for ten or so years.Id put it all out of my mind and moved on,so I panicked a wee bit when I saw my results.My creatinine levels have also risen so I'll ask about that.Hopefully it's just a blip.Sometimes I wish I had an A level in biology then I'd grasp the science more quickly.I don't discuss these details with my grown up children as they tend to worry!

Hi. What kind of numbers are you getting ? As you will see from my comment in reply to @Bluetit1802, all kinds of small things can have an impact on creatinine.
 

Glenmac

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@pleinster Hi,the last three tests the levels were 70,63,96.These are usually taken around 11am and are none fasting.
 

Bluetit1802

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I'm sure your own slightly elevated levels will indeed be down to food/drink before a test, particularly if other tests have been excellent and you are not talking about a figure above 150.

Goodness, no. My highest ever level was 78 (not fasting). I'm in the mid to high 50's (fasting). I clearly have no personal concerns, I was just interested in the difference it makes whether fasted or not fasted, and there obviously is a difference. So thank you for your interesting information. I hope it helps @Glenmac
 
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Glenmac

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@Bluetit1802 This is very interesting,I'm learning all the time,Thankyou!Ive got a HbA1c next week and then a GP appointment.Im considering fasting before this test.I guess I may be concerned for no reason.In the past I have just accepted advice,meds etc without too many questions,trusted HPs,kept my head down and got on with life.(That's my generation,not having the Internet to get more information!!)To be honest I've had excellent care at critical times.Just recently a serious error was made,so I'm not quite so trusting!
 

Bluetit1802

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@Bluetit1802 This is very interesting,I'm learning all the time,Thankyou!Ive got a HbA1c next week and then a GP appointment.Im considering fasting before this test.I guess I may be concerned for no reason.In the past I have just accepted advice,meds etc without too many questions,trusted HPs,kept my head down and got on with life.(That's my generation,not having the Internet to get more information!!)To be honest I've had excellent care at critical times.Just recently a serious error was made,so I'm not quite so trusting!

As your HbA1c test will (or at least should) include cholesterol and a full lipid panel, you would be wise to fast anyway. A non-fasting test does affect the levels of triglycerides, particularly if you have had a fatty meal/snack beforehand. This is a well known fact, not just my opinion.

As for accepting everything doctors and nurses say without questioning it, I stopped doing this 5 years ago when I was diagnosed with breast cancer. Since then I have always asked for every print out available, copies of letters from the hospital to GP, and copies of all my biopsy and operation lab reports. Doctors are too fond of filtering out information for whatever reason, and declaring us as "fine" or "OK" when in fact we may be teetering on the edge of not being - and I need to know that so I can do something about it.
 

pleinster

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@pleinster Hi,the last three tests the levels were 70,63,96.These are usually taken around 11am and are none fasting.

Hi. If these are indeed blood creatinine levels they are all perfectly normal ! The "normal" range is between 60 and 110 mmols per litre. I would not even consider 130 to be "high". I hope that reassures you.
 

Bluetit1802

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Hi. If these are indeed blood creatinine levels they are all perfectly normal ! The "normal" range is between 60 and 110 mmols per litre. I would not even consider 130 to be "high". I hope that reassures you.

Is it different for men and women? My lab standard range is 46 to 92. As @Glenmac seems to have her print outs/on-line stuff, she should be able to see what her lab standard range is.
 
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Glenmac

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@pleinster and@Bluetit1802 Yes the range for creatinine levels are higher for women it states on the results(Once I found the correct button to press!)......60 to 120.Many thanks for your help.
 

pleinster

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Is it different for men and women? My lab standard range is 46 to 92. As @Glenmac seems to have her print outs/on-line stuff, she should be able to see what her lab standard range is.

Hi. The 46 sounds a bit low but I guess different places have different ways of looking at things for some reason. I think if its 46 its still not an issue and really only indicates that the kidneys are still fine...but I don't understand how the top end is only 92 as having attended clinics in both Scotland and England over decades, I have always been told that 100-110 is perfectly normal. In fact, depending on age and size, 125 would still be considered normal. it is worth bearing in mind that while 110 would be perfect for a fit athlete, it would be too high for a wee girl. Maybe the lab you are referring to likes things flagged up around 92 so further tests could reassure medical staff, but 110 in general is definitely still normal blood serum creatinine.
 

JohnEGreen

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My latest was eGFR of 50

also
Serum creatinine level 128 umol/L [70.0 - 120.0]
Above high reference limit

My eGFR just keeps going down previously was 63.
 

pleinster

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My latest was eGFR of 50

also
Serum creatinine level 128 umol/L [70.0 - 120.0]
Above high reference limit

My eGFR just keeps going down previously was 63.


John just thought I''d say that the eGFR can be out by a substantial amount (even as much as 20%) in terms of actual kidney function and is nowhere near an exact science. On the surface 50 doesn't sound great and I can see why the apparent drop form 63 would worry you...but that creatinine level is really ok...don't be too worried, mate.
 
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JohnEGreen

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Thanks @pleinster that's reassuring only thing is eFGR has now been low over two or three years so is chronic not an acute change am going to ask doc if he can take me off Aspirin and prescribe something else and I have been taking Metformin not to control blood sugars but to suppress apatite so am going to discontinue that and see if it helps.
 

Bluetit1802

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Thanks @pleinster that's reassuring only thing is eFGR has now been low over two or three years so is chronic not an acute change am going to ask doc if he can take me off Aspirin and prescribe something else and I have been taking Metformin not to control blood sugars but to suppress apatite so am going to discontinue that and see if it helps.

I think your plan to drop Metformin is excellent. It shouldn't be prescribed when there are kidney issues. I'm sure NICE mentions this somewhere.
 

pleinster

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I think your plan to drop Metformin is excellent. It shouldn't be prescribed when there are kidney issues. I'm sure NICE mentions this somewhere.

Yup. On diagnosis a couple of months after my transplant (ie. with one kidney and about 55% function), I was prescribed Gliclazide and was told Metformin generally avoided with renal patients.
 

Biggles2

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was told Metformin generally avoided with renal patients.

This is 2016 guidance is from the European Medicines Agency (I'm not sure if this guidance has been adopted by NICE):

Up to now, metformin medicines were not recommended for patients with moderate to severe
reduction of kidney function. This recommendation has now changed to allow their use in patients
with moderately reduced kidney function (GFR=30–59 ml/min). The dose of metformin should be
adapted depending on the patient’s kidney function. These medicines should still not be used in
patients with severely reduced kidney function (GFR less than 30 ml/min).​

http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2016/10/WC500214248.pdf
 

pleinster

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This is 2016 guidance is from the European Medicines Agency (I'm not sure if this guidance has been adopted by NICE):

Up to now, metformin medicines were not recommended for patients with moderate to severe
reduction of kidney function. This recommendation has now changed to allow their use in patients
with moderately reduced kidney function (GFR=30–59 ml/min). The dose of metformin should be
adapted depending on the patient’s kidney function. These medicines should still not be used in
patients with severely reduced kidney function (GFR less than 30 ml/min).​

http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2016/10/WC500214248.pdf

My transplant was in Edinburgh is 2015 and renal specialists in conjunction with diabetes consultant would not prescribe metformin despite my initial post-op eGFR of over 60. Maybe though that is just hospital policy with all transplant patients as the function is prone to change and is usually lower than that. Personally, I would not risk metformin if I had any worries over kidney function. I would add that I chucked the Gliclazide pretty quickly too as I wanted to be able to see exactly what difference I could make through diet alone. Still, we are all variations on a theme and I would never totally disregard medical advice on my kidneys.
 

Biggles2

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. Still, we are all variations on a theme and I would never totally disregard medical advice on my kidneys.
Absolutely, @pleinster you have to be so careful with the kidneys. I just added this info to this thread as it was a change that was publicized last year. The FDA in the US approved it for a lower eGFR as well. However, in the presence of kidney disease, or after a transplant like yourself, your renal specialist is, and should only be, the go to person on this.
 

JohnEGreen

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I have definitely decided to drop the metformin as I don't need it for controlling BG now so any risk is no longer off set by the benefits.
 
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