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Old 01-19-2010, 09:52 PM   #1
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Deteriorating GFR: Going from Stage 3B CKD to Stage 4

Based on my analysis of blood tests, my 70-year old aunt currently has Stage 3b CKD and is actually close to Stage 4.

Back in 8/2008, her GFR was 49.5. A year later, it's 32. This is a loss of 17.5ml/min over 12 months. Every test I looked at, her BUN (22-23), Creatinine (1.3-1.6) and Choloride (112) are elevated.

I suspect it was out of control hypertension which caused her kidney function to deteriorate. I measured her BP at 200/110 several occasions over the weekend. Her resting BP was around 160/100.

I don't know what her internist has been doing but they apparently thought her hypertension was under control. She stopped taking Hydrochlorothiazide 25mg, something she was on, a while ago.

I've made an appointment with her internist so that a nephrologist can be seen. What are we looking at here? I'm more concerned about the rapid decline in GFR than her 3b being so close to 4. We just ordered her November blood results to be sent and I'm afraid to look at the results and see really how low her GFR has gotten this time.

 
Old 01-21-2010, 05:32 PM   #2
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Re: Deteriorating GFR: Going from Stage 3B CKD to Stage 4

Her BP is very high. I would say she definitely should get back on the HCT. Alot of internist's and nephs will put a CKD pt on an ACE inhibitor, as they are known to protect the kidneys.

It's good your looking out for her. I agree, she should be under the care of a nephrologist.

Leea

 
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Old 01-21-2010, 05:43 PM   #3
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Re: Deteriorating GFR: Going from Stage 3B CKD to Stage 4

Good BP control is necessary, for both her kidney function, and to avoid stroke. I had 4 simultaneous strokes at age 43 due to hypertension, which also resulted in kidney failure. You are very wise to keep this a top priority. I am currently taking several BP meds, that my nephrologist has designed for my personal situation, but BP control is a daily struggle for me. I am also in Stage 4, at the age of 49.

 
Old 01-22-2010, 07:15 AM   #4
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Re: Deteriorating GFR: Going from Stage 3B CKD to Stage 4

Quote:
Originally Posted by dolby View Post
Based on my analysis of blood tests, my 70-year old aunt currently has Stage 3b CKD and is actually close to Stage 4.

Back in 8/2008, her GFR was 49.5. A year later, it's 32. This is a loss of 17.5ml/min over 12 months. Every test I looked at, her BUN (22-23), Creatinine (1.3-1.6) and Choloride (112) are elevated.

I suspect it was out of control hypertension which caused her kidney function to deteriorate. I measured her BP at 200/110 several occasions over the weekend. Her resting BP was around 160/100.

I don't know what her internist has been doing but they apparently thought her hypertension was under control. She stopped taking Hydrochlorothiazide 25mg, something she was on, a while ago.

I've made an appointment with her internist so that a nephrologist can be seen. What are we looking at here? I'm more concerned about the rapid decline in GFR than her 3b being so close to 4. We just ordered her November blood results to be sent and I'm afraid to look at the results and see really how low her GFR has gotten this time.
First off, it is a good thing that you are going to get her to see a nephrologist. Many studies have shown that the earlier an intervention by a neph, the better the results.

It is important to get her bp under control and a neph will be very good at doing that and further protecting her kidneys.

Try to not get too obsessed with the gfr. First off, it is an estimate. Secondly, it is only one test in many that are used to determine the extent of kidney damage. To put things into a bit of perspective for you, any creatinine level below 1 is pretty much normal. The 1.3 to 1.6 is slightly elevated. I didn't go on dialysis until I hit about 9. Granted, I did wait a bit too late, but it took me 20 years to get there. I am not a doctor, but with proper treatment and following docs orders regarding diet and medications, it is quite possible that you aunt will die of natural old age before anything severely kidney related occurs.

I have been through the entire spectrum - over 20 years pre-dialysis, a year on dialysis and then a transplant. So feel free to ask any questions.
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Old 01-23-2010, 06:53 AM   #5
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Re: Deteriorating GFR: Going from Stage 3B CKD to Stage 4

That was the question I had. I myself have been on Lisinopril 20mg, which protects my kidneys. Any particular reason why she was prescribed the water pill (HCZL) -- that is, the diuretic variety of hypertension medication?

Btw, my aunt also has Hepatitis B and is being treated by a liver specialist. I believe she's doing all she can to avoid liver cancer (HCC) and cirrhosis. But the drug she takes (Hepsera) is also known to damage kidneys. So we have a double whammy here: high BP and the known, kndney-damaging medication which she has to take for her Hep B.

Quote:
Originally Posted by leea1206 View Post
Her BP is very high. I would say she definitely should get back on the HCT. Alot of internist's and nephs will put a CKD pt on an ACE inhibitor, as they are known to protect the kidneys. It's good your looking out for her. I agree, she should be under the care of a nephrologist. Leea

Last edited by dolby; 01-23-2010 at 08:13 AM.

 
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