Hi Rita,
I don't blame you for being worried. Learning that our kidneys might not be functioning properly is not a good feeling.
Some situations call for a referral to a nephrologist. In stages 1 and 2 of chronic kidney disease, these might include increases in urine protein, fast rate of GFR decline (more than 10% a year), consistently high levels of potassium, blood in urine, very high albumin/creatinine ratio and other abnormal test results.
In stage 3, referral to a nephrologist or an internist should be considered if eGFR rate of decline is over 10% per year and/or urine protein is increasing.
In stage 4, - eGFR 15-29, every patient should be referred to a nephrologist or an internist.
In stage 5, an urgent referral is necessary. A person should be under the care of a nephrologist before reaching this stage of the disease.
The goals of therapy in chronic kidney disease are to control blood pressure to a target level, reduce proteinuria to slow the progression and to control cholesterol. Your eGFR is very good
, but the protein level should come down (if possible). ACE inhibitors and Angiotensin receptor blockers have been shown to reduce proteinuria in most people, but not everyone. Statins are used for cholesterol control. Lifestyle modifications are also very important, especially when overweight. Weight loss and a controlled protein intake can reduce proteinuria or microalbumineria and also improve blood pressure control. These treatments can be easily initiated by general physicians. In addition to administering the proteinuria/ blood pressure and cholesterol reducing drugs, kidney function is monitored via blood tests and urinalysis. Unless there are multiple CV risk factors and/or complications, the kidney function is monitored twice a year. As the GFR falls and symptoms develop, the frequency of testing increases. So, your doctor is right in a way, a nephrologist would probably just monitor your labs, like mine did in the beginning. The protein level
HAS to be watched. If it persists or you start seeing an upward trend -instead of a gradual reduction-, you should
insist on a referral to a nephrologist. Try not to worry too much. Good luck!
flowergirl
