How should I monitor my chronic kidney disease?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Based on the information you have provided, your kidney function is currently reassuring. An eGFR (estimated glomerular filtration rate) that has returned to 59 mL/min/1.73 m² after an initial drop suggests that the earlier decline may have been related to starting Ramipril rather than permanent worsening of kidney function. A small fall in eGFR after starting an ACE (angiotensin-converting enzyme) inhibitor such as Ramipril is expected, provided it stabilizes and there is no significant rise in potassium.

For someone with stable chronic kidney disease, the usual follow-up includes:

1. Serum creatinine and eGFR every 6 to 12 months if kidney function remains stable. If medications are changed or the kidney function starts declining, testing may be needed more frequently (every one to three months initially).

2. Urine albumin-to-creatinine ratio (ACR) at least once a year to check for protein leakage, as this is an important marker of kidney disease progression.

3. Electrolytes, especially potassium, should be checked after starting or increasing Ramipril and then periodically thereafter.

4. Blood pressure should be monitored regularly, even if it has always been normal.

I would like to know:

1. Was your diagnosis based only on the eGFR, or was protein found in your urine as well?

2. Have you had a urine albumin-to-creatinine ratio (ACR) test?

3. Do you have diabetes, heart disease, or a family history of kidney disease?

Your current blood pressure of 115/60 mmHg (millimetres of mercury) is appropriate, and your fasting glucose appears normal. The main goals now are to keep your blood pressure controlled, avoid dehydration, avoid NSAID (non-steroidal anti-inflammatory drugs) painkillers such as Ibuprofen or Naproxen unless specifically advised, and continue regular follow-up with your physician or nephrologist.

If your eGFR falls below 45 again, your creatinine rises progressively, significant protein appears in the urine, or your potassium becomes elevated, your doctor may recommend closer monitoring or additional investigations.

Overall, based on the values you've shared, your kidney function appears stable at present, but regular monitoring of eGFR, creatinine, potassium, and urine ACR is the best way to detect any future changes early.

I hope this helps.

Thank you and take care.

Regards.

Hello,

Welcome back to icliniq.com.

Thank you for the additional information. That actually changes my level of concern in a reassuring way.

An eGFR by itself is not enough to diagnose significant chronic kidney disease. Kidney disease is diagnosed when there is evidence of kidney damage (such as albumin or protein in the urine or abnormal imaging) or when the eGFR remains below 60 mL/min/1.73 m² for at least three months.

In your case:

• Your eGFR has recovered to 59.

• There is no protein on routine urine testing.

• Your blood pressure is well controlled.

• Your blood sugar is normal.

This suggests that your risk of rapid progression is relatively low, although continued monitoring is still important.

The one investigation I would definitely recommend discussing with your physician is a urine albumin-to-creatinine ratio (ACR). A routine urine dipstick can miss small amounts of albumin, whereas the ACR is much more sensitive and is one of the best predictors of future kidney health.

Regarding your grandfather, a single family member who developed kidney disease many decades ago does not necessarily mean you have an inherited kidney disorder, especially since dialysis and routine screening were not available at that time. However, it is still worth mentioning this family history to your doctor.

Based on everything you've shared, I would recommend discussing:

1. Urine ACR now (if never done).

2. Serum creatinine, eGFR, and potassium every six months initially.

3. Annual urine ACR if the first result is normal.

4. Blood pressure checks at each routine visit.

I would also like to know:

1. Have you ever had a kidney ultrasound?

2. Do you know your serum creatinine value, or have you only been told the eGFR?

3. Has your doctor explained what they think caused the reduced eGFR in the first place?

One point that stands out is that your eGFR dropped to 43 after starting Ramipril and then recovered to 59. That pattern is reassuring and does not suggest rapidly progressive kidney disease. It would be helpful to know whether the improvement occurred after better hydration, repeat testing, or a change in medication.

Overall, I think obtaining a urine ACR will provide the missing piece of information and give a much clearer picture of your true kidney risk.

I hope this helps you.

Hello,

Welcome back to icliniq.com.

Thank you for clarifying.

Yes, ACR stands for albumin-to-creatinine ratio. Could you please tell me what the ACR result was? It looks like your message was cut off before the value came through.

If your ACR was within the normal range (generally less than 3 mg/mmol or less than 30 mg/g, depending on the units your laboratory uses), that would be very reassuring. Combined with your current eGFR of 59 and stable blood pressure, it would suggest a low risk of progression and support routine monitoring rather than intensive follow-up.

After you send the ACR value (and the units, if available), I will explain exactly what it means in the context of your kidney function and whether any additional testing or changes in follow-up are needed.