Why has my kidney function dropped significantly at age 19?

Question

Hello doctor,

I am a 19-year-old male. My eGFR eight months ago was 145, and today I found out that it is 63. My creatinine level is elevated at 134, and my urea level is also high at 10.8. I also have protein in my urine, which was detected using a urine dipstick test. I am experiencing severe fatigue, and sometimes I notice foamy urine and flank pain. I also have low folate levels and low MCHC. What could this possibly indicate?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand the concern.

Based on the information, kidney function has declined significantly, with estimated glomerular filtration rate (eGFR) decreasing from 145 to 63 within eight months. An eGFR of 63 in a 19-year-old male is concerning, as normal kidney function at this age is generally above 90 milliliters per minute per 1.73 square meters.

Elevated creatinine (134 micromoles per liter) and elevated urea (10.8 millimoles per liter) further confirm reduced kidney function. The presence of protein in urine, foamy urine, and flank pain suggests kidney injury associated with proteinuria. Proteinuria is not normal at this age and often indicates glomerular disease, meaning damage to the filtering units of the kidneys.

Severe fatigue, low folate levels, and low mean corpuscular hemoglobin concentration (MCHC) may indicate developing anemia. Anemia in this context could be related to kidney dysfunction, nutritional deficiency, or a combination of both.

The possible causes in a person of this age group include:

Primary glomerular diseases, such as immunoglobulin A nephropathy (IgA nephropathy), focal segmental glomerulosclerosis, minimal change disease, or membranous nephropathy.
Secondary causes, including lupus nephritis (associated with systemic lupus erythematosus), post-infectious glomerulonephritis, or vasculitis.
Hereditary or structural conditions, such as Alport syndrome, reflux nephropathy, or polycystic kidney disease.
Other systemic conditions, including poorly controlled hypertension, diabetes mellitus (less likely at this age without prior history), or kidney damage related to drugs or toxins.

The current features includes rapid decline in kidney function (from 145 to 63 within eight months). Proteinuria combined with reduced kidney function at a very young age. Systemic symptoms such as fatigue, anemia, and flank pain.

I would recommend the following investigations:

Complete urine analysis with protein quantification, such as a spot urine protein-to-creatinine ratio or a 24-hour urine protein measurement.
Renal ultrasound to assess for structural abnormalities.

Blood investigations include:

Electrolytes, albumin, calcium, phosphate, parathyroid hormone (PTH),
Autoimmune screening (antinuclear antibody (ANA).
Antineutrophil cytoplasmic antibody (ANCA).
Anti–double-stranded deoxyribonucleic acid (anti-dsDNA).
Complement levels.
Screening for hepatitis.
Human immunodeficiency virus (HIV).

This situation should not be ignored. At 19 years of age, kidney function is expected to be normal. The described changes are significant and require urgent evaluation by a nephrologist to prevent further decline and to determine the underlying cause.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.