| Orthostatic left-overs in later adulthood?
I have an eGFR that dropped from 98 to 77 about 3 years ago and has since fluctuated in the mid 70's to mid 80's.
Last fall tests at the nephrologit's office showed up with about 200 mg of protein in 24h urine collection (183mg and 219 mg on repeat). No HBP or diabetes. The 24 h creatinine clearance corrected improved on repeat from 88 to 107.
Nephrologists says it's all fine and I just have "43yo kidneys" but no actual dx of CKD.
I ended up in his office because I insisted for a referral with my GP even though she did not think I needed it.
Unfortunately, it was very hard for me to accept what he says since numbers fit into the CKD Stage 2, by textbook.
A few days ago I had my 6 months follow-up which I have been very anxious about for half a year now.
As I desperately wanted to avoid any errors in collection that might lead to inaccurate results (as I suspected last time), I first did a practice/mock 24 h collection. I didn't' want to to throw it away though so I took it to a consumer lab. It was careful to do 100% correct collection and it came back with <110 mg per 24h.
I was beyond happy but still had a tiny reservation as I had not eaten much protein at all during the collection day. I also lied down in recumbent position for most of the day.
A few days later I completed the actual follow-up collection with the nephrologist's office.
This time, however, I had to stay on my feet all day as we had guests that week-end.
Considering the exhilarating protein result of just a few days before, I was shocked to see the protein at 288 mg this time; even higher than in the Fall last year!
e-GFR was at 72 and while I was somewhat dehydrated when I had the blood drawn, this is my lowest number yet. Serum creatinine was at 0.96, slightly higher than what determined me to ask for referral from my GP in the first place (when it went to 0.04). In the meantime, I'd had 0.89, 0.84 with the nephrologist and even 0.80 at the ER where I went for anxiety/panic attack and I had not eaten for a few days; with the latest test, it jumped back up to 0.96.
Yet, the creatinine clearance 24h, corrected for bidy surface improved even further from last value to a quite high 122.
So I saw a drop in eGFR and rise in protein, but a marked improvement in Urine Cr Clearance/24h.
With a 122, even if it overestimates GFR by 20%, it would still suggest a renal function in the high 90's. Yet my eGFR says low 70's.
I have plunged into desperation, maximum anxiety and helplessness and my family is suffering terribly.
My question is: if I had <110 mg of protein on a day of mainly lying down and then only a few days later, 288 mg on a day when I ran around all day...could it be possible that I may have a very mild form of orthostatic response that causes me to excrete a bit more urine during the day than I normally should? This condition which is considered benign is mainly found in children and young adults and is supposed to be rare after 30...but the two recent protein tests point exactly to such postural interference?
I am 44 yo and my son's pediatrician told me that orthostatic proteinuria can remain as a tendency throughout life, even if it subsides in adulthood and can come and go.
I plan on asking my dr to let me do a split 16h / 8 h urine collection to see if I drop that excess protein during the day but not at night when I lie down.
Any reassurance would be tremendously appreciated at this point.
I just want to believe what my dr. says - that I don't have a CKD dx, despite some slightly weird numbers.
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