Abnormal Kidney Function: What You Need to Know

Q: Abnormal Kidney Function: What You Need to Know

1. <br>First, let's discuss the risk factors for kidney disease： the three highs (hypertension, hyperglycemia, and hyperlipidemia) and proteinuria. <br>Based on the data you provided： Blood Pressure??? Blood Glucose (GLU AC) 89 mg/dL： OK; Lipid Profile Cholesterol 224 mg/dL： bord

Is there any abnormality in kidney function?

Hello, Doctor.
Last July, I had a urinalysis that showed hematuria and proteinuria, both positive.
In August, I went to another hospital for another urine test, and again, there were reactions for hematuria and proteinuria.
After blood tests and an ultrasound, the doctor informed me that there was no need to worry too much, and my kidney function was fine.
I remember being told that 97% of normal individuals have similar findings, but I didn't fully understand the actual situation.
I was only advised to follow up every six months.

In May of this year, I visited another nephrologist, and the urinalysis still showed hematuria and proteinuria, with proteinuria being ++.
After an ultrasound and blood tests, I received detailed information indicating that my kidney function was slightly impaired, but it was not yet at the stage requiring treatment.
I was instructed to have check-ups every three months.
During a follow-up visit, I was asked to provide a urine sample on short notice, and after drinking a lot of water, I found that there was no proteinuria, but hematuria was still present.
Was this due to the urine being diluted? I didn't ask the doctor about the reason at that time; I was only told to monitor my glucose levels.
Here are some of my lab results:
- Glucose (AC): 89 mg/dL
- Cholesterol: 224 mg/dL (H)
- Triglycerides: 91 mg/dL
- Immunoglobulin G: 1160 mg/dL
- BUN: 17 mg/dL
- Immunoglobulin M: 123 mg/dL
- Creatinine: 1.1 mg/dL
- Immunoglobulin A: 290 mg/dL
- Uric Acid: 6.3 mg/dL
- Kappa: 856 mg/dL
- Lambda: 646 mg/dL
- ALT: 22 U/L
- AST: 20 U/L
- Protein: 7.7 g/L
- Albumin: 5.4 g/L (H)
- A/G Ratio: 2.3
I remember that kidney function is related to creatinine levels, which have consistently been 1.1 mg/dL.
Looking back at my health check records from five years ago, it was also 1.1 mg/dL (with normal urine).
I have been dealing with issues of proteinuria and hematuria, and based on online calculations, it seems to indicate stage 2 chronic kidney disease.
I feel very complicated and worried.
Is my kidney condition severe compared to normal individuals? The doctor mentioned that my kidney function is already impaired, and I fear that one day I may need dialysis.
What should I do now? Could you please tell me about my current situation? Thank you very much, Doctor.

HS, 20~29 year old female. Ask Date: 2012/06/12

Dr. Wu Jiyu reply Internal Medicine

1.
First, let's discuss the risk factors for kidney disease: the three highs (hypertension, hyperglycemia, and hyperlipidemia) and proteinuria.
Based on the data you provided: Blood Pressure??? Blood Glucose (GLU AC) 89 mg/dL: OK; Lipid Profile Cholesterol 224 mg/dL: borderline high; Proteinuria: no data.
Recommendations: a.
Measure your blood pressure daily (preferably <130/80 mmHg).
b.
Manage hyperlipidemia (start with diet and exercise; if levels do not improve, consider medication).
c.
Please have your physician check your Urine Protein-to-Creatinine Ratio (UPCR).
2.
Regarding kidney function (Creatinine: 1.1), the estimated Glomerular Filtration Rate (eGFR) is currently 87.4 ml/min, which is slightly low for your age (normal should be greater than 90 ml/min).
However, the creatinine level has remained stable at 1.1 over the past five years, indicating slight kidney impairment but relatively stable function.
I recommend that you follow the above care plan for your kidneys and consult a nephrologist for proper management and long-term follow-up.
Changhua Hospital's nephrology department is here to support you.

Reply Date: 2012/06/12

More Info

Understanding abnormal kidney function can be quite complex, especially when faced with terms like proteinuria (presence of protein in urine), hematuria (presence of blood in urine), and fluctuating kidney function tests. Based on your description, it seems you have been experiencing some concerning symptoms and test results over the past year, including persistent proteinuria and hematuria, alongside stable creatinine levels.

First, let's clarify some key points regarding kidney function and the tests you've undergone. The kidneys filter waste products from the blood, regulate electrolytes, and maintain fluid balance. When they are functioning well, the levels of creatinine (a waste product from muscle metabolism) in the blood remain stable, typically within the range of 0.7 to 1.3 mg/dL for most adults. Your creatinine levels have consistently been around 1.1 mg/dL, which is within the normal range, suggesting that your kidney's filtering ability is still intact.

However, the presence of protein and blood in your urine is a red flag. Proteinuria can indicate kidney damage or disease, as healthy kidneys typically do not allow significant amounts of protein to pass into the urine. Hematuria can arise from various causes, including urinary tract infections, kidney stones, or more serious conditions like glomerulonephritis or tumors. The fact that you have consistently tested positive for both protein and blood in your urine warrants further investigation.

Your doctors have mentioned that your kidney function is not at a stage requiring treatment yet, which is a positive sign. However, the recommendation for regular follow-ups every three months is crucial. This monitoring allows for early detection of any deterioration in kidney function or the emergence of other complications. The fluctuation in your urine tests, where you had no protein or blood after drinking a lot of water, could indeed be due to dilution. Hydration can temporarily affect the concentration of substances in urine, but persistent findings of protein and blood should be taken seriously.

Regarding your concerns about chronic kidney disease (CKD), it’s important to understand that CKD is classified into stages based on the glomerular filtration rate (GFR) and the presence of kidney damage. Your stable creatinine levels suggest that you may not be in an advanced stage of CKD, but the ongoing proteinuria and hematuria indicate that there is some level of kidney damage that needs to be monitored.

To manage your kidney health moving forward, consider the following steps:
1. Regular Monitoring: Continue with your scheduled follow-ups and urine tests. This will help track any changes in your kidney function over time.

2. Lifestyle Modifications: Adopt a kidney-friendly diet that is low in sodium and protein, as excessive intake can put additional strain on your kidneys. Staying hydrated is also important, but balance it with your doctor's advice, especially if you have any restrictions.

3. Blood Pressure and Diabetes Management: If you have high blood pressure or diabetes, managing these conditions is crucial for protecting your kidneys. Regularly monitor your blood pressure and blood sugar levels.

4. Avoid Nephrotoxic Substances: Be cautious with medications and supplements that can harm the kidneys. Always consult your doctor before starting any new medication.

5. Seek Specialist Care: If you feel uncertain about your current management plan, consider seeking a second opinion from a nephrologist (kidney specialist) who can provide more tailored advice based on your specific situation.

In conclusion, while your current kidney function appears stable, the presence of protein and blood in your urine is concerning and should be closely monitored. By following your doctor's recommendations and making lifestyle adjustments, you can help protect your kidney health and potentially prevent further deterioration. Remember, early intervention is key in managing kidney disease effectively.

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