How To Treat Low Kidney Function
Although there is no cure for chronic kidney disease , your doctor can work with you to treat and manage your existing symptoms, reduce underlying issues, and find ways to slow down disease progression. Some of the treatments are universal, while others depend upon the stage of CKD you are in.
A healthy diet and lifestyle combined with appropriate medications for symptom control is the most common treatment for kidney disease in its early stages. Renal replacement therapy, such as dialysis or a kidney transplant, is reserved for end-stage kidney disease .
For Older Adults Questioning A Diagnosis Of Chronic Kidney Disease
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Is it really possible that half of the population older than 70 has chronic kidney disease?
International guidelines adopted in 2012 make it seem that way. They define the disease in terms of how efficiently kidneys filter the waste from our blood, a measure called the glomerular filtration rate. Healthy young people commonly have G.F.R.s of about 120. A G.F.R. lower than 60 or another marker of kidney damage for more than three months means chronic kidney disease.
At which point, patients become scared. When youre told you have a disease, thats a bad day, said Dr. Ann OHare, a nephrologist at the University of Washington in Seattle who specializes in treating older adults. Patients worry about dialysis, because thats what they associate with kidney disease.
Chronic kidney disease causes no symptoms until its later stages, and most seniors with the diagnosis are told theyre at Stage 3, of five sudden, unwelcome news. Because Medicare uses these benchmarks for billing and reimbursement, theyve become, in effect, the official definition of the disease for older Americans.
But wait a minute. Kidney function declines with age in almost everyone, and the proportion of older people with G.F.R. readings below 60 approaches 50 percent, studies have found. As the older adult population grows, the prevalence may rise even higher.
Why are we even thinking about this as a disease?
How should they respond?
Counting Blood Cells And Components
Problems such as anaemia and infection can be detected by counting amounts of these blood components in a blood sample:
- haemoglobin normal levels are approximately 110-180 grams/litre in men and 115-165 grams/litre in women
- white blood cells a normal count is approximately 4-11 thousand million per litre
- platelets a normal count is approximately 150-350 thousand million per litre
- albumin normal levels are 35-45g/litre.
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What Do Your Kidneys Do
You have two kidneys. They are bean-shaped organs that are located toward your back, on either side of your spine, just underneath the rib cage. Each kidney is about the size of your fist.
Your kidneys have many jobs, but their main job is to filter your blood, getting rid of toxins and excess salt and water as urine. If your kidneys are damaged and dont work as they should, wastes can build up in your blood and can make you sick. Your kidneys also balance the amount of salts and minerals in your body, make hormones that control blood pressure, make red blood cells and keep your bones strong.
Stages Of Kidney Disease
The term chronic kidney disease is used worldwide to mean any form of kidney disease that goes on for more than a few months.
The word ‘chronic’ doesnt necessarily mean ‘serious’ and the word ‘disease’ includes any abnormality of kidney structure or function, whether or not it is likely to cause a person to feel unwell or to develop complications.
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How Is Your Glomerular Filtration Rate Measured
The glomerular filtration rate measurement comes from the name of the filtering units inside your kidneys, called the glomeruli.
Glomeruli are complex structures made of tiny blood vessels called capillaries, along with protein mesh and layers of tissue that continuously filter your plasma. Each glomerulus is housed within a structure called a Bowmans capsule. Based on 2020 research, between your 2 kidneys, you have about 2 million glomeruli.
A number of formulas are used by groups like the National Kidney Foundation to calculate GFR. But the measurement essentially takes into consideration your gender, age, body size, and your blood creatinine level.
- 0.9 to 1.3 milligrams per deciliter in adult men
- 0.6 to 1.1 milligrams per deciliter in adult women
These levels can vary. For example, in a 2009 research review, creatinine levels fell by an average of 0.4 milligrams per deciliter in pregnant women.
Because they can change with age and size, creatinine levels alone are not good indicators of kidney health. The GFR takes these other elements into account.
Most GFR results simply provide you with a measurement of 60 or higher, since you can have stage 1 or 2 kidney disease, but still have normal kidney function. This changes when your GFR drops below 60. Under 60, you begin to have some loss in function.
What Does Your Gfr Mean For You
Your eGFR helps identify your level of kidney function. Each stage of kidney disease matches up to an eGFR range, and knowing which stage youre in can help you identify the steps you need to take to stay your healthiest. People in early stages 1-3 of CKD, for example, may want to focus on lifestyle changes and eating a kidney-friendly diet. People in later stages CKD 4 and 5 may need to find a nephrologist and explore treatment options, such as a kidney transplant or dialysis. Use the chart below to determine which CKD stage best matches your GFR calculator results and click on the stage to learn about healthy next steps.
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Stage 5gfr Of 15 Ml/min Or Less
Patients at Stage 5 have chronic CKD. They have a GFR of 15 mL/min or less and have End Stage Renal Disease .The kidneys have lost almost all ability to function effectively at this stage. They will need dialysis or a kidney transplant to live.
Our kidney specialists can work with you to provide individualized evaluation and treatment, taking into consideration your GFR and other factors. To learn more or schedule an appointment at one of our clinics call 412-802-3043 or toll free 1-800-533-UPMC .
You should discuss this result with your kidney specialist.
The Amount Of Urine I Produce Has Not Decreased Doesn’t That Mean My Kidneys Are Functioning Alright
The kidneys still produce the same amount of urine up to – and even after – a patient with kidney failure first starts dialysis. Kidney function is described using the term “glomerular filtration rate,” or GFR. The GFR in a person with normal kidney function is 120 milliliters per minute. This means that each minute 120 milliliters is filtered from the blood into the kidneys. After three minutes, the amount filtered by the kidneys from the blood is about the same amount of fluid as in a can of soda. Over a 24-hour period, the total fluid filtered by the kidneys from the blood in a patient with normal kidney function is roughly 50 gallons! Of course, people do not produce 50 gallons of urine per day. That is because the kidneys reclaim over 99% of the water and minerals filtered by the kidney into roughly two quarts of urine. Therefore, a patient with kidney function that is 20% of normal will still filter 10 gallons of fluid from the blood per day. That person still produces two quarts of urine just like someone with normal kidney function, but only eliminates 20% of the kidney poisons in the urine compared to a person with normal kidney function.
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Blood Tests That Measure Diabetes Control
A blood glucose test measures the amount of a type of sugar in your blood. Glucose is your blood sugar. It is measured to make sure your body is able to digest and utilize sugar and carbohydrates correctly. If your blood sugar is too high, it may mean you have diabetes.
Normal Fasting Glucose levels:
- No known diabetes: less than 100 mg/dl
- Above 125 mg/dl can indicate diabetes
- Diabetics: 70-130 mg/dl is within target range
- No known diabetes: less than 140 mg/dl
- Diabetics: less than 180 mg/dl
A glycosylated hemoglobin A1C reading reveals your average blood glucose level over the past three months and can be used to monitor your diabetic control and to predict your risk for diabetic complications. How does it do that? Your body actually memorizes the trail that sugar leaves in your body. When blood glucose is high, the sugar molecules attach themselves to red blood cells. The red blood cells store the sugar information for about four months. A blood test can then retrieve your average blood glucose results in the format of a percentage. The greater your A1C value, the higher your risk for diabetic complications. For the diabetic with CKD, good control of your blood sugar can slow the worsening of kidney function. Ask your doctor what your result should be. For most people, the result should be less than 7%.
What Is Kidney Dialysis
Because there is no cure for CKD, if you are in late-stage disease, you and your healthcare team must consider additional options. Complete kidney failure, left untreated, will result in death. Options for end stages of CKD include dialysis and kidney transplantation.
Dialysis is a procedure that uses machines to remove waste products from your body when your kidneys are no longer able to perform this function. There are two major types of dialysis.
Hemodialysis: With hemodialysis, your blood is circulated through a machine that removes waste products, excess water and excess salt. The blood is then returned to your body. Hemodialysis requires three to four hours, three times a week and is performed at a clinic, hospital or dialysis center.
Peritoneal dialysis: In peritoneal dialysis, a dialysis solution is run directly into your abdomen. The solution absorbs waste and then is removed via catheter. Fresh solution is added to continue the process of cleaning. You can perform this type of dialysis yourself. There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis , which involves a change in dialysis solution four times a day and continuous cycling peritoneal dialysis . CCPD uses a machine to automatically fill, remove wastes, and refill the fluid during the nighttime.
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What Are Good Gfr And Creatinine Numbers
GFR and creatinine are usually measured and reported together. GFR is the best measure of kidney function, but creatinine can also be a helpful indicator of your kidney health. It’s a bad sign if your GFR goes down or your creatinine goes up. In general, a “good” GFR number is above 60, and a “good” creatinine number is below 1.2.
Are There Stages Of Chronic Kidney Disease
Yes, there are five stages of kidney disease. The stages are based on how well your kidneys are able to do their job to filter out waste and extra fluid from your blood. The stages range from very mild to kidney failure . Healthcare providers determine the stage of your kidney function according to the glomerular filtration rate . Your GFR is a number based on the amount of creatinine, a waste product, found in your blood, along with other factors including your age, race and gender.
|Stages of Chronic Kidney Disease|
- Are African-American, Hispanic, Native American or Asian.
- Are over 60 years of age.
- Have a long history of taking painkillers, including over-the-counter products such as aspirin and ibuprofen.
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How Is It Tested
As part of standard blood tests, your doctor can check the creatinine level to assess kidney function. Creatinine is released from muscle cells into the blood stream.
Creatinine is one of the things that the kidneys filter from the blood. If the kidneys start to lose some function, blood creatinine level rises. The creatinine level is used to calculate an estimate of the GFR and provide an estimate of your kidney function.
Most people who have a minor reduction in kidney function can take steps to not keep the kidneys from getting worse. If the function is somewhat low but stable, you may need to see your doctor only once per year. If the GFR is declining or it is already under 50, it’s best to see a kidney doctor, if for no other reason than to become educated.
How high blood pressure damages the kidneys
High blood pressure can cause tiny cracks in the lining of arteries, which provide a breeding ground for fatty deposits that hamper blood flow. As the arteries that feed blood to the kidneys narrow, the body produces renin, a hormone that makes small arteries narrow further. This worsens high blood pressure, causing even more kidney damage. Over time, restricted blood flow can damage or destroy the nephrons, the tiny filtering units inside your kidneys.
What Do Egfr Numbers Mean
Healthcare providers measure eGFR in milliliters of cleansed blood per minute per body surface .
Values for eGFR vary depending on age, sex and other factors. The rate naturally declines as you age and lose muscle mass. The average eGFR for someone in their 20s is about 116 mL/min/1.73m2. It drops to 85 mL/min/1.73m2 for people in their 60s.
An eGFR higher than 60 means you have at least 60% kidney function. Generally, the higher the number, the better your kidney function.
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What Are Kidney Numbers
The two numbers youll need to become familiar with to assess your kidney health are your albumin to creatinine ratio and your estimated glomerular filtration rate . Well refer to these as your kidney numbers.
The ACR measures how much of the protein albumin is present in your urine. This protein is not bad your body needs it. But it should be in your blood, not your urine. If too much of it is present, that could indicate one or both of your kidneys are not functioning properly. Your ACR can be assessed through a simple urine sample.
The eGFR measures the amount of creatinine in your blood, then plugs that number into a formula that takes into account your age, gender, and body size. The resulting number is your eGFR. As you may remember, creatinine is a waste product that should be in the urine, not the blood, if your kidneys are functioning properly. With a simple finger prick blood test, a doctor can evaluate the amount of creatinine in your blood and estimate your GFR.
Note: Your actual GFR number is more complicated to determine and requires experienced personnel, so it is typically only performed in research settings and transplant centers. The eGFR is recommended as a sufficient measure of kidney health by the National Kidney Foundation. The eGFR is typically a reliable indicator of kidney health but in some cases could be inaccurate and require further testing, particularly if you have had a limb amputated, are malnourished, or highly obese.
Glomerular Filtration Rate Based On Creatinine Measurement
GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation requires only a measurement of the creatinine in a blood sample.
Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When kidneys are not working well, creatinine builds up in the blood.
In the lab, your blood will be tested to see how many milligrams of creatinine are in one deciliter of blood . Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. If your creatinine level is only slightly above this range, you probably will not feel sick, but the elevation is a sign that your kidneys are not working at full strength.
One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.
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Test Results And Stages Of Ckd
Your test results can be used to determine how damaged your kidneys are, known as the stage of CKD.
This can help your doctor decide the best treatment for you and how often you should have tests to monitor your condition.
Your eGFR results is given as a stage from 1 of 5:
- stage 1 a normal eGFR above 90ml/min, but other tests have detected signs of kidney damage
- stage 2 a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney damage
- stage 3a an eGFR of 45 to 59ml/min
- stage 3b an eGFR of 30 to 44ml/min
- stage 4 an eGFR of 15 to 29ml/min
- stage 5 an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function
Your ACR result is given as a stage from 1 to 3:
- A1 an ACR of less than 3mg/mmol
- A2 an ACR of 3 to 30mg/mmol
- A3 an ACR of more than 30mg/mmol
For both eGFR and ACR, a higher stage indicates more severe kidney disease.