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Old 07-22-2012, 08:12 AM   #1
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Help with lab results

Just received my labs and have following......I do see a Nephrologist and have been diagnosed with mid stage kidney failure however labs have come in with new #s that I would like to hear about before my next appt.

All below are out of range

Globulin: Low 2.0. Range: 2.1 - 3.7
Albumin/globulin ratio: high 2.3. Range: 1.0 - 2.1

Protein/creatinine Ratio: High 304. Range: 22 - 128
Protein total random UR: High 45. Range: 5 - 25

White blood cell count: High 10.9. Range: 3.8 - 10.8

Glucose: High 105. Range: 65 - 99

Hemoglobin A1C: High 5.9. Increased risk for diabetes

Occult blood. Trace

Protein: 1+. (out of range)

Any thoughts to results meaning is much appreciated.

 
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Old 07-22-2012, 01:33 PM   #2
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Re: Help with lab results

Most of your numbers are not that far out of range except for the protein in the urine. Were the protein numbers determined by a random urine sample taken in the doctors office or a 24/hr urine assay? Something I don't understand from your results are the urine Protein/Creatinine ratio which you give at 304 with a range of 22-128. The normal accepted range for this ratio is <0.2 and when it is above 0.3 may indicate Nephrotic syndrome. When calculating this ratio all units must be the same, that is mg/dL to mg/dL or grams to grams. The ratio holds true for both random and 24/hr urine testing as close correlation has been proven. Although you inferred that all your other tests were normal it would be helpfull if you provided your actual serum Bun, Creatinine, eGFR and calculated urine Creatinine Clearance Level.
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Old 07-22-2012, 02:13 PM   #3
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Re: Help with lab results

First of all, do you know what has caused the kidney problems, or is this a relatively new diagnosis? It appears you have both blood and protein in your urine, which normally indicates nephritis (inflammation) of some kind. Do you have lupus? Previous rheumatic fever? Known diabetes? Have you had a kidney biopsy? It helps when evaluating labs to compare current values to previous values to see the general trend if it is stable, improving or worsening. Fluctuations from test to test are normal, so it takes more than 2 testings to see a trend of any kind. I agree that your creatinine, BUN, and EGFR would be helpful parts of the picture. Also it appears you may have mildly impaired glucose tolerance and a dietician to help you watch your diet to control blood sugar would help as that can compromise your kidney function as well.

 
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Old 07-22-2012, 04:24 PM   #4
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Re: Help with lab results

Yes...I had a blockage at birth at bladder that was corrected by surgery in 1972. The result left the one kidney very small and the other very large to compensate poor function. Occult blood is normal based on this. However the Globulin and Albumin/Globulin ratio out of norm is new.

This is a periodic lab work up I get before appt done in lab. No 24 hr assay.

The measurement for the protein/creatinine ratio is 22 - 128 mg/g creat. Normal range .... Mine came in at 304

The protein total random UR is 5 - 25 mg/dl.....normal range.....mine was 45

creatinine is 1.29........ Normal range is .60 - 1.35 mg/dl
Bun is 17........... Normal range is 7-25 mg/dl
eGFR is 66......... Normal range is > or = 60 mL/min/1.73m2

No Lupus, rheumatic fever, no diabetes but have consistent 5.9 A1C

I was thinking to call MD and see if any further tests should be done before appt early Aug....and should I get any updated ultrasound?

I have had a biopsy about 8 - 9 years ago.

Thoughts....with this additional info? Thank you!!!

 
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Old 07-22-2012, 04:25 PM   #5
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Question Re: Help with lab results

Yes...I had a blockage at birth at bladder that was corrected by surgery in 1972. The result left the one kidney very small and the other very large to compensate poor function. Occult blood is normal based on this. However the Globulin and Albumin/Globulin ratio out of norm is new.

This is a periodic lab work up I get before appt done in lab. No 24 hr assay.

The measurement for the protein/creatinine ratio is 22 - 128 mg/g creat. Normal range .... Mine came in at 304

The protein total random UR is 5 - 25 mg/dl.....normal range.....mine was 45

creatinine is 1.29........ Normal range is .60 - 1.35 mg/dl
Bun is 17........... Normal range is 7-25 mg/dl
eGFR is 66......... Normal range is > or = 60 mL/min/1.73m2

No Lupus, rheumatic fever, no diabetes but have consistent 5.9 A1C

I was thinking to call MD and see if any further tests should be done before appt early Aug....and should I get any updated ultrasound?

I have had a biopsy about 8 - 9 years ago.

Thoughts....with this additional info? Thank you!!!

 
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Old 07-23-2012, 11:45 AM   #6
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Re: Help with lab results

Dave:

I am still confused about your last post where you state that your lab Protein/Creatinine ratio is 22-128 mg/g. I think what you are looking at is the actual Random urine creatinine range not the ratio. In addition the units you give of mg/g cannot be. I suspect they are actually in mg/dL. The normal Random urine creatinine concentrations range for men is 40-300 mg/dL subject to Lab. variations. Assuming this is the case your actual Protein/Creatinine ratio would be 0.15 which is within the the normal ratio range of 0.20 max. ( 45mg/dL divided by 304mg/dL) However your Random urine creatinine and protein numbers are still quite high.

I am surprised that your doctors have not specified a 24/hr urine assay. While a Random urine test will give you a snapshot in time of these results it is not as thorough as the 24 hr. test which is considered (even with its faults) the gold standard for kidney investigations.

One urine test while important will not completely define a condition. Usually a number of serial tests conducted over months will establish a trend or stability for kidney problems.

Vanbill

 
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Old 07-23-2012, 03:10 PM   #7
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Re: Help with lab results

Dave, Your kidney function is minimally affected according to the creatinine, and you are spilling some protein but not a lot. The protein spilled from the kidneys is normally albumin, which can lower serum albumin and make the ratio of globulin to albumin hi, as they are relative to one another. I am more used to seeing 24 hr urine proteins, but this amount of protein looks pretty mild compared to what it can look like. Protein/creat. ratio is also relative, so elevated protein in urine is going to raise that ratio. Do you know what your biopsy from years ago showed? This situation may stay stable for years without causing you problems, but it needs to be monitored regularly. Two really important things to prevent are high blood pressure and diabetes. I would get to work on weight loss, if you need it, lowering your salt intake, and doing everything you can to control your blood sugars to get the HBA1C down. Even though it is slightly elevated, it shows a predisposition to diabetes and you can protect your kidneys from further problems now by diet control. I would just watch how your numbers trend over time, but not worry. This is probably related to your early problems and surgery. An US occasionally wouldn't hurt.

 
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Old 07-23-2012, 05:11 PM   #8
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Re: Help with lab results

So Nephrologist has ordered a CT of lower abdomen/pelvic area and ultrasound of kidneys. I also had indications of stones previously. Thanks again for your counsel.

 
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