Significant Drop in eGFR: Should You Be Concerned About Kidney Health?

The most recent test showed a significant decrease in glomerular filtration rate (GFR)?

Hello, Doctor.
I am currently 29 years old, 153 cm tall, and weigh 50 kg.
Last year, during a company health check, I was found to have elevated fasting blood glucose levels (118), but my hemoglobin A1c was normal (5.2).
A month later, I went to a nearby clinic for a follow-up, and the results came back normal (90).
The doctor speculated that it might have been due to not fasting long enough that day, but still recommended monitoring because I was quite alarmed.
I have been actively exercising and controlling my diet.
At the end of last year, my weight was 55 kg, but it has now decreased to 50 kg.
Since then, I have been doing regular check-ups at the nearby clinic or laboratory every 1-3 months, with blood glucose levels generally ranging between 88-92, not varying much.
My cholesterol levels are maintained with HDL around 60-80 and LDL around 105-120, but my total cholesterol is relatively high, ranging from 200-220.
Each time, I also have tests for creatinine, uric acid, blood urea nitrogen, and glomerular filtration rate (GFR).
In previous tests, my GFR was between 90-110, with one instance showing a value of 150.
I have researched that GFR is estimated based on creatinine levels.
However, this month, I am uncertain if my dietary changes (intentionally reducing carbohydrate intake and increasing protein) have significantly lowered my GFR to below 90.
Comparing the results from October to now (December 2):
- eGFR: 108.7 → 78.68
- BUN: 13.4 → 16
- Creatinine: 0.68 → 0.9
- Uric Acid: 5.3 → 5.3
- Blood Glucose: 88 → 71
- Cholesterol: 216 → 203
- Triglycerides: 98 → 48
- HDL: 73.6 → 47
- LDL: 118.4 → 111
- Blood Pressure: 124/76 → 118/78
There is no protein, glucose, or occult blood in my urine, and the urine pH is 5.
The significant decrease in GFR has made me very anxious.
Am I possibly in stage 2 kidney disease? Should I seek immediate consultation with an internist or nephrologist? I have been drinking about 3000-4000 cc of fluids, but before this blood draw, I was worried about the test results and fasted for over 12 hours, only drinking 200 cc of water within that time.
Thank you, Doctor, for taking the time to read this lengthy message.

Wang Yonghe, 20~29 year old female. Ask Date: 2021/12/03

Dr. He Yonghe reply Internal Medicine

Hello Ms.
Wang, drinking less water can also lead to a decrease in eGFR.
Generally, 2500-3000 cc per day should be sufficient.
If your cholesterol is elevated, dietary changes and exercise can help improve it.
You may consider visiting an internal medicine specialist for further evaluation.

Reply Date: 2021/12/03

More Info

The significant drop in your estimated glomerular filtration rate (eGFR) from 108.7 to 78.68 is understandably concerning, especially given your previous normal results. eGFR is a crucial indicator of kidney function, and a decrease can suggest potential kidney issues. However, it's essential to interpret these results in the context of your overall health and lifestyle.

Firstly, eGFR is calculated primarily based on serum creatinine levels, which can fluctuate due to various factors, including hydration status, muscle mass, and dietary changes. In your case, you mentioned a recent dietary adjustment where you reduced carbohydrate intake and increased protein. Such changes can influence creatinine levels, as a higher protein intake can lead to increased creatinine production. Additionally, dehydration can also lead to a temporary increase in serum creatinine, which would subsequently lower the eGFR.

Your recent blood tests show that while your eGFR has decreased, your creatinine levels have also increased slightly from 0.68 to 0.9. This change, while still within the normal range, indicates that your kidneys may be under some stress or that there are changes in your muscle metabolism or hydration status affecting these values.

Moreover, your blood urea nitrogen (BUN) has increased from 13.4 to 16, which could also suggest a change in kidney function or hydration status. However, the absence of proteinuria, glycosuria, and hematuria in your urine tests is a positive sign, indicating that there may not be significant kidney damage at this point.

Given your age (29 years) and the absence of other risk factors such as diabetes, hypertension, or a family history of kidney disease, it is less likely that you are experiencing advanced kidney disease. However, the drop in eGFR does warrant further investigation. It is advisable to consult a nephrologist (kidney specialist) or an internist who can evaluate your kidney function more comprehensively. They may recommend additional tests, such as a repeat eGFR in a few weeks, urine tests for microalbumin, or imaging studies to assess kidney structure.

In the meantime, maintaining adequate hydration is crucial, especially if you are increasing your protein intake. Drinking 3000-4000 cc of fluids daily is generally good, but ensure that you are not overdoing it, as excessive fluid intake can also strain the kidneys. Continue monitoring your blood pressure and blood sugar levels, as these can also impact kidney health.

Lastly, lifestyle modifications, including a balanced diet rich in fruits, vegetables, and whole grains, regular physical activity, and avoiding excessive salt and processed foods, can help support kidney health. Regular follow-ups with your healthcare provider to monitor your kidney function and overall health are essential.

In summary, while a drop in eGFR can be concerning, it is crucial to consider the broader context of your health. Consulting with a healthcare professional for further evaluation and guidance is the best course of action.

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