Kidney disease measurement - formulas correctness??!!

[ajk]

Hi all,

Recently (3 months back) my brother age 43 was diagnosed kidney disease in India. He never had any problems with Kidneys before and he got to know about it during his health check ups in last January 2005. His blood test showed 'creatinine' of 3.9 and a DTPA (renal scan) showed GFR of 42%. He had abnormal urea level as well. Doctor advised him that around 50-60% of Kidney function still remaining. He was also having a slight elevated blood pressure 140/95 and doctor thought that probably his BP in the past would have remain elevated and might be some problem of Kidneys itself - Both would have made spoiled his Kindey functions. Doctor advised him ACE inhibitor and after having the drug for 3 weeks his BP was like 100/70.

Now he comes back to Ireland where he lives and meets a Consultant here and gets his another blood test done (after 3 weeks from the starting of Ace inhibitors) and the blood result after 3 weeks showed 'creatinine' rising upto 5.2 and similar increase in his urea level.

As his BP was remaining perfect, he, in Consultation with the Doctor, stopped the ACE inhibitors and its like now 3 months since and his BP has never increased (its always in the range of 110/70).

He again got his blood test done on February 14 2005. This time the 'creatinine' comes to 4.1 (decrease of 1.1 from the last reading) and similar decrease in urea level. Doctor on the basis of GFR calculating formulas mentioned to him that his kidney function is only 20% and come back after a month for another blood test. He also asked him to go through the Creatinine clearance test. He went for another blood test after a month and this time his 'cretanine' was 3.8 (decrease of 0.3 from the last) and also a decrease in his urea level.

After seeing these readings, Consultant calculated on the basis of Cockroft-Gault and MDRD formulas that his Kindey functions are only 18% left.

Now I have a big confusion and a question here. How could the DTPA scan taken at India could show 42% GFR whereas these GFR formulas mentioned here in Ireland would show the same as 18%??! What's the actual position with regards to hid Kidney function??!

Just a quick info about him - He is age 43, 173 cms height, weight 54 Kg (initially weight got decreased around 2-3 kgs but in recent 15 days he has recovered like 1 kg weight) - always been around 59-60 kgs in his life.

Your help in this regard will be very much appreciated.

Thanks.

ajk

[nenad]

Formulas are just that : formulas. Some might be better than others, but they are still just approximation of the real value. They need to measure GFR by some more direct method. It's also possible that his kidney function is deteriorating fast.
I suggest you read the book "Coping with kidney disease: A 12-step program to help you avoid dialysis". You'll find a few things about the accuracy of these tests.
Good luck, I guess.

[ajk]

Thanks for your reply nenad. I'll advise him to go through this book.

If anyone has faced similar situation in the past, please let me know.

Regards,

ajk

[whatamuse]

Those tests really do vary in results. The body is mercurial that way.

I've had cret so high i was told i was in kidney failure only for it to normalize quickly. I only have one kidney so i was scared. Doctors cannot accurately diagnose how much kidney function is left. When mine was removed i was told it had about 20% function and it had zero.

Either way it is certainly cause for great concern. Symptoms can be more telling than tests sometimes. I too am on an ACE and have been for years and have had no increase in cret levels with it. High blood pressure left untreated can cause kidney failure.

best!

[whatamuse]

PS: I think a kidney biopsy is the way they tell how much function there is, but many will not do so as it is very dangerous. Quite.