Test results

[Lyndaye]

I had my bloods and urine samples taken last week for my annual review. I'm in Scotland so have access to my results through 'my diabetes my way'. Most of my results are now loaded on to the system but my eGFR result isn't there yet. When I checked back all of my previous results are recorded as >59 ml/min. Does anyone know whey there isn't an exact number recorded, and should I be worried with this result of >59ml/min? On another note I've lowered my HbA1c to 50 from 69 last year, which I'm pleased about.
Thanks

 

[Bluetit1802]

Hi,

At one time the required level for an eGFR was 60, so as you were "more than 59", that was fine. However, the goalposts have moved now and the required level is now above 90. Hopefully your lab has cottoned on to the new required level.

 

[Lyndaye]

Thanks, that probably explains it.

 

[Guzzler]

Well done on your numbers. Result!

 

[ringi]

They may do a quick and cheap eGFR test, and if someone is clearly OK, not do the more expensive test to get an exact result.

 

[Lyndaye]

Results are now in and eGFR is recorded as >59 again. Apart from my weight all my other results are better (or in the case of my eGFR, the same) than they were last year. Now just need to lose about 4 stone and get my blood pressure down a bit further (not classed as high just now but heading that way).

 

[TheBigNewt]

The GFR refers to the "glomerular filtration rate" and is a simple calculation based on your serum creatinine (blood test), your weight, maybe age. It refers to kidney funtion. The serum creatinine is the key element (usually around 1.0 in the US). I wouldn't get to wrapped up in the GFR if I were you. I've never looked at it in any patient I've treated. I just look at the creatinine.

 

[Lally123]

The GFR refers to the "glomerular filtration rate" and is a simple calculation based on your serum creatinine (blood test), your weight, maybe age. It refers to kidney funtion. The serum creatinine is the key element (usually around 1.0 in the US). I wouldn't get to wrapped up in the GFR if I were you. I've never looked at it in any patient I've treated. I just look at the creatinine.

Not sure if you're from the UK or not but here serum creatinine is considered to be an unreliable marker of kidney function with eGFR being accepted as the best marker to establish and monitor a patients renal function. The calculation takes into account variables which a standard creatinine doesn't.

 

[TheBigNewt]

Not sure if you're from the UK or not but here serum creatinine is considered to be an unreliable marker of kidney function with eGFR being accepted as the best marker to establish and monitor a patients renal function. The calculation takes into account variables which a standard creatinine doesn't.

So doctors there rely on the GFR not the serum creatinine? I feel sorry for them, because in order to do a proper creatinine clearance without utilizing the serum creatinine it requires the patient submit a urine sample usually comprising 24 hours. We ain't got time for that over here lol. Remember if, as you say, the serum creatinine "is considered to be an unreliable marker of kidney function" then it must not be utilized in any fashion in the method that replaces it. Otherwise its assumed errors would be baked into the GFR that's derived from it. In my prior post I did point out what's probably factored into the simple GFR that we use.

 

[Lally123]

So doctors there rely on the GFR not the serum creatinine? I feel sorry for them, because in order to do a proper creatinine clearance without utilizing the serum creatinine it requires the patient submit a urine sample usually comprising 24 hours. We ain't got time for that over here lol. Remember if, as you say, the serum creatinine "is considered to be an unreliable marker of kidney function" then it must not be utilized in any fashion in the method that replaces it. Otherwise its assumed errors would be baked into the GFR that's derived from it. In my prior post I did point out what's probably factored into the simple GFR that we use.

We use both here, my point in answer to yours was that we would.never rely just on serum creatinine as you said you Did, because here eGFR is considered to be a superior marker of kidney function. 24 hr creatinine clearance is rarely done here now, used to be commonplace about 15 years ago.

 

[ringi]

I expect the calculated GFR is more useful for deciding if it is safe to give people some drugs then the "raw" serum creatinine. But if I was tracking my own kidney function to see how it changed over time, I would use the serum creatinine.

 

[Bluetit1802]

In England we are now given a new status on our blood test results - Acute Kidney Injury Stage (AKI). This should help if anyone is worried.

 

[TheBigNewt]

We regard a bump in the creatinine from 1.2 to 1.4 to be significant, and might affect the use of loop diuretics or spironolactone in heart failure, the use of an ACE inhibitor, or ARB, or the use of a drug like digoxin. Not sure that bump would significantly change your calculated GFR though. We see tons of Type 2's with renal insufficiency and proteinuria. I use a registered pharmacist in the next office if I have drug questions in renal failure. But we may not have caught up to you after starting Obamacare lol.

 

[ringi]

Often in the UK, there is no history of creatinine tests result, hence a GP has to decide what drugs are safe based on a single set of blood tests. (However, there should be a history of test results for anyone with Type2.) I think GFR cutoff are given in the prescribing guidelines.

For some reason, doctors in the UK don't look at changes in test results as much as the current set of results. When looking at my own results, I care more about the shape of the graph, then absolute values, but this may be because I have been trained in complex systems and that is how engineers tend to think.

 

[TheBigNewt]

Often in the UK, there is no history of creatinine tests result, hence a GP has to decide what drugs are safe based on a single set of blood tests. (However, there should be a history of test results for anyone with Type2.) I think GFR cutoff are given in the prescribing guidelines.

For some reason, doctors in the UK don't look at changes in test results as much as the current set of results. When looking at my own results, I care more about the shape of the graph, then absolute values, but this may be because I have been trained in complex systems and that is how engineers tend to think.

For example: many times the PCP will prescribe a low dose of lisinopril (and ACE inhibitor) to a Type 2 diabetic as in some cases it can lessen the effects of diabetes on renal function or microalbuminuria. But if their creatinine is already borderline they'll certainly want to recheck it and make sure it doesn't go up as well as the serum potassium. Here at the VA we have what is perhaps the oldest continuous use electronic medical records systems (called CPRS) in the world. You can find vets' lab results from WAY back there, probably to 2000, from any VA facility in the country.

 

[Bluetit1802]

Often in the UK, there is no history of creatinine tests result, hence a GP has to decide what drugs are safe based on a single set of blood tests.

I can see my test results on-line back to 2011 for liver and kidney functions. They form part of the routine health checks we get. The serum creatinine is part of this.

We regard a bump in the creatinine from 1.2 to 1.4 to be significant,

Which measurement units are these? In the UK it is umol/L and the standard range on my lab reports is 46 to 92.

 

[ringi]

I have liver and kidney functions test result going back many years, as I waas considered high risk due to my mother's medical history. My wife has only had 1 or 2 sets of blood tests in her life. Hence it very much depends on the person if there are past test results for a GP to compare to current results.

 

[TheBigNewt]

Which measurement units are these? In the UK it is umol/L and the standard range on my lab reports is 46 to 92.

Mg/dl is what we use. Blood sugar normal is 60-110. We take your number and multiply times 18. Different for creat. Ours is 0.7-1.1 I think.

 

[Bluetit1802]

Mg/dl is what we use. Blood sugar normal is 60-110. We take your number and multiply times 18. Different for creat. Ours is 0.7-1.1 I think.

I wasn't meaning units for blood sugar levels, I meant units for serum creatinine. You mentioned figures such as 1, 1.2 and 1.4. They don't relate to our range of 46 to 92umol/l

 

[TheBigNewt]

I wasn't meaning units for blood sugar levels, I meant units for serum creatinine. You mentioned figures such as 1, 1.2 and 1.4. They don't relate to our range of 46 to 92umol/l

I believe the measurements we use for serum chemistry items are mg/dl. There's a conversion table somewhere out there.