Do I have CKD based on lab results or Nephrologist opinion?

Question
QUESTION: Dear Dr. Shah,

This would be a very long question if I tried to put everything in here. But here goes, GFR 50, creatinine 1.1 last year. This year GFR 53 creatinine 1.1- given 24 hour cc test which gave GFR 59 and creatinine 1.2 ( range .6-1.0) referred to a Nephrologist who was very brief with me  He looked at labs quickly and said I don't think you have CDK ( thought I was in stage 3?) He said I don't have hypertension or diabetes. All other parts of lab look ok. He said he did not pay attention to GFR's and that 1.2 was normal for a women of almost 60 yrs. He said he could only be sure if he checked for protein ( I didn't have any) in my urine with a multistix. His opinion was NO Protein...NO CKD. It took me 6 weeks before my Nephrologist visit and I read what seemed like every medical abstract on the web before I came to the appointment. I am rather dumbfounded. I was only in his office about 10 minutes.  I'm not sure what to believe. I understand you can not diagnose me.  But, I was wondering what your take would be on this?  Do you suggest I get a second opinion? Did I dodge a bullet? Maybe I have mild CKD? I'm baffled. Sorry for such a long post. It seems that everything I read supported the fact that I had CKD if I had a low GFR? Yikes!



Thank you for your time,



Diane



ANSWER: Hi Diane,



Thanks for asking my help on "Allexperts".



Ten minutes is too short a time to spend with a patient. It takes me at least 45 minutes for a first consult. Also, there can be many conditions when a patient has CKD but no protein in the urine.



That said, if you do not have diabetes and hypertension, if your physical examination, other labs and ultrasound are within normal limits, I would not worry too much. As I had said in earlier answers, an eGFR reading must always be viewed in light of suggestive symptomatology and lab readings.



To put your mind at ease, why don't you ask for a second opinion, preferably from  someone at a University hospital?



Sincerely,



Dr. Shah



---------- FOLLOW-UP ----------



QUESTION: Dear Dr. Shah,



Thank you so much for your kind response. I've probably read every response in the archives that you have written. I am going to take your suggestion about a second opinion. I have another thought. Is it in the normal range ( albeit low normal) to have a 50+ GFR at my age? Is it also very possible my GFR is under-estimated even on the 24 hour CC test? I've read the Mayo Clinic paper that says that GFR is often underestimated on people without prior evidence of renal disease? Perhaps as much as 26 percent or more. I don't believe the Nephrologist looked at my 24 hour CC test. I wonder if he would have given the 24 hour CC test more credibility and therefore reconsidered his NO CKD diagnosis? Also, even if my (around) 50+ GFR is age related isn't that low enough to create hyperfiltration and therefore kidney damage.  Hence, progression no matter what the initial cause of a low GFR. Or does a low GFR due to age and not disease respond differently? By the way, I work in the mental health field and the correct diagnosis is paramount in providing the appropriate treatment. I'm having a hard time with having positive lab results yet so much confusion as to whether I have CKD or not. Do you have some general thoughts about what I have written?  Thank you again for responding to me. I've talked more to you than I was able to talk in my first Nephrologist visit. Something is wrong with that picture ;-) So, I really appreciate your time and advice.



Thank you,  ( sorry so many questions, just trying to figure it all out!)



Diane


Answer
Hi Diane,



Thanks for following up with me.



In normal people, GFR reduces by 1 ml/min/1.73 m2 every year after the third decade of life. If you are a small person, it is possible that you started out with a lower "normal" GFR.



A 24 hour CC is more reliable than an estimated GFR.



Sincerely,



Dr. Shah