Dr. Pankaj Jawandhiya
Nephrology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 62-year-old very fit male. I lift weights three times a week and use the stair master for 30 minutes five times a week vigorously. I have had this same routine for the past 20 years. I am 5'7" and weigh 160 pounds. My serum creatinine was 1.33 16 years back, and for the past 16 years, it has fluctuated from 1.34 to 1.48. There was one test done last year that came back at 1.2. However, the latest test result was 1.38. All other values are normal. BUN is always around 15 to 20. My spot urine protein was 7 and my spot creatinine was 85. Based on the serum creatinine levels alone my eGFR is low indicating stage 3 CKD. This seems crazy to me. All my blood work is perfect except for the creatinine. My lipids are great, my BP is 120/75, my fasting glucose is 98 to 100, and A1c is always 4.6 to 4.8. I am not on any drugs, I do not take creatine supplements, I do not take any medication. I do not take NSAID.
If I had stage 3 CKD, would the urine levels be indicative of disease? Also, how can the creatinine be elevated with normal BUN? If CKD, would the kidneys not functioning increase the BUN at the same time? This makes no sense to me. Since level has held steady for 16 years, is that evidence of no disease? I have been told that higher muscle mass may lead to elevated creatinine, but I do not have huge muscles. Is it possible that the muscle metabolism from exercise is always creating elevated creatinine? Does this sound like stage 3 CKD to you? I have had Gilbert's disease so bilirubin is always elevated at about 2 to 3 for the past 40 years. No other conditions.
Hello,
Welcome to icliniq.com.
I went through your reports (attachment removed to protect patient identity), see basically beyond 40 years of age, there is 1ml/min/1.73 m2 decline in eGFR per year, and that is a normal physiological response because of an increase in age, same as skin wrinkles, since you have high creatinine, but is static and there is no protein in urine, your chronic kidney disease is very slowly progressing.
Differential diagnosis, in this case, is chronic tubulointerstitial disease or benign nephrosclerosis, as you told you are not taking any drugs, NSAIDS, gym supplementation. About confirming the diagnosis, it will need a kidney biopsy to confirm it.
But whatever disease it is, it is slowly progressive and mostly probably will behave same way for next 10 to 15 years. What you need to do is restict protein in diet to 0.8 gm/kg/ day, less salt, blood pressure monitoring. Avoiding alcohol, tobacco products, weight management.
Patient's Query
Thank you doctor,
Finally, an answer that made a bit of sense and helped in explaining. Just one follow up, please. If my eGFR is decreasing at 1ml/min/1.73 m2, then by the time I am 82 years old it will be down to 25 and ready for dialysis. That is too young. My grandfather lived to 105. I want the same. Is there anything we can do to slow the progression? Any drugs that will slow progression? If I stop using weight training and allow muscles size to shrink, will that help?
Hi,
Welcome back to icliniq.com.
See, basically, eGFR is not the only criteria to start or stop dialysis, though your kidney will undergo age-related senescence so as your muscle fiber, and less creatinine production through muscle when you measure eGFR, it will be greater than actual. The thing I want to say is do not go by number, that is all.
Regarding arresting the progression, low salt in the diet, low protein as I advised earlier, and if possible get kidney biopsy done to detect underlying pathology so that if something is there that is treatable, we can do that. Do not allow the muscle to shrink, let it be a natural progression, avoid vigorous activity and weight training, normal weight training thrice a week is fine. Avoid any protein supplementation and all that sort of things.
Patient's Query
Thank you doctor,
I am trying to understand the last comment you sent. If my eGFR is 57, you stated that if they actually measure the GFR it has a possibility of being higher. So is that a potentially higher measured GFR than an eGFR? Is this a normal finding that the measured comes back higher? So maybe I am only in stage 2? Maybe the reason for the elevated creatinine has less to do with kidney dysfunction, and more to do with muscle metabolism from weight training and exercise and larger muscle mass. Since all other kidney tests are beautiful. My BUN and ratios and spot urine, all look really good. Maybe I am worrying too much.
Hi,
Welcome back to icliniq.com.
eGFR will be higher because of low mass and decreased creatinine because of that, and the last thing you said is absolutely right. You are worrying too much, and because of that, I am advising you to get kidney biopsy done to sort things out for once and all.
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Nephrology
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