Glomerular Filtration Rate and Proteinuria: A Patient's Concerns

Hello, Dr. Wu. Could you please explain the relationship between glomerular filtration rate and proteinuria?

Hello Dr.
Wu, in my last hospital check-up report, my glomerular filtration rate (GFR) was highlighted in red at 83 mL/min/1.73 m², with a reference value of greater than 90.
There was also a urine occult blood result of 1+ and urine protein at 30 mg/dL, which is slightly low.
After three months, I went to the clinic for a follow-up, and my GFR was 71.01 mL/min/1.73 m², with a reference value of greater than 60.
Why is the reference value for the first test greater than 90 and for the second test greater than 60? The first test had a red flag, but the second test had a lower number and did not have a red flag.
When I asked the nurse at the report desk, she only told me that there is still a little urine protein and to follow up regularly.
Does this mean my kidney function is getting worse? Am I at risk of needing dialysis? Should I go to a larger hospital for a more detailed examination? Thank you!

Jiang, 20~29 year old female. Ask Date: 2016/05/02

Dr. Wu Jiyu reply Internal Medicine

Hello, the glomerular filtration rate (GFR) used by hospitals is estimated based on formulas derived from past research statistics on patients with chronic kidney disease.
Factors such as age, weight, body composition, gender, and ethnicity can all influence the calculation of this index.
For younger individuals with normal kidney function, the calculated index has limited reference value and may not necessarily indicate a significant change in kidney function during follow-up tests; it is far from suggesting the need for dialysis.
However, since your follow-up urine tests showed microalbuminuria, clinically, proteinuria may indicate early kidney damage.
It is recommended that you bring these urine test results to a nephrologist for further evaluation and quantitative urine protein testing to determine if it represents early kidney disease.
This information is for your reference, and it is still advisable to consult a nephrologist to assess your actual condition.

Reply Date: 2016/05/02

More Info

Understanding your concerns about glomerular filtration rate (GFR) and proteinuria is crucial, especially given the implications these measurements have for kidney health. Let's break down your situation and clarify what these results mean, as well as the next steps you might consider.

Glomerular Filtration Rate (GFR)
GFR is a key indicator of kidney function. It measures how well your kidneys are filtering blood, with normal values typically above 90 mL/min/1.73 m². Your initial GFR of 83 mL/min/1.73 m² was slightly below the normal range, which can indicate early kidney dysfunction. However, your follow-up GFR of 71.01 mL/min/1.73 m² suggests a further decline in kidney function. A GFR below 60 mL/min is often considered indicative of chronic kidney disease (CKD), and values below 15 mL/min may require dialysis or kidney transplantation.

Proteinuria
Proteinuria, or the presence of excess protein in the urine, can be a sign of kidney damage. Your initial urine protein level of 30 mg/dL is considered low, but the presence of protein in the urine is still a concern. The fact that you had a "1+" reading for urine protein indicates that there is some protein present, which could suggest ongoing kidney issues.

Interpretation of Results
The fluctuation in your GFR and protein levels can be concerning. It is not uncommon for kidney function to vary over time due to various factors, including hydration status, blood pressure, and underlying health conditions such as diabetes or hypertension. The decrease in GFR from 83 to 71.01 mL/min suggests a decline in kidney function, which should be monitored closely.

Next Steps
1. Regular Monitoring: It is essential to continue regular monitoring of your kidney function and protein levels. Your healthcare provider may recommend follow-up tests every few months to track changes in your GFR and proteinuria.

2. Consult a Specialist: Given the decline in your GFR and the presence of proteinuria, it may be beneficial to consult a nephrologist (kidney specialist). They can provide a more detailed assessment and may recommend additional tests, such as a 24-hour urine collection for protein or imaging studies to evaluate kidney structure.

3. Lifestyle Modifications: Maintaining a healthy lifestyle can help protect your kidneys. This includes controlling blood pressure, managing blood sugar levels if you have diabetes, staying hydrated, and following a balanced diet low in sodium and protein.

4. Medication Review: If you are on medications that may affect kidney function, such as certain pain relievers or blood pressure medications, discuss these with your doctor. They may adjust your medications to better protect your kidneys.

5. Addressing Underlying Conditions: If you have conditions like hypertension or diabetes, controlling these effectively is crucial in preventing further kidney damage.

Conclusion
While your current results indicate a decline in kidney function, it is important to remember that kidney health can often be managed effectively with appropriate medical care and lifestyle changes. Regular follow-ups and consultations with your healthcare provider will be key in monitoring your condition and preventing progression to more severe kidney disease or the need for dialysis. If you have any further concerns or symptoms, do not hesitate to seek medical attention promptly.

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