Where It All Started

My new primary care physician – a term I use interchangeably with family doctor or simply physician in this blog – was looking at the results of current blood and urine tests when she started asking me those questions I couldn’t answer. I’d always accepted that copies of my quarterly blood tests were in my file at the doctor’s office and I’d be informed if there was a liver problem since I was taking these tests to monitor how my medication was affecting my liver function in the first place.

Pretend you are looking at my test results. On top, above the results section, was all the information needed to identify these as my tests and the information that this was a fasting test, no eating or drinking after midnight the day before the blood and urine were collected.  Following are explanations of the different parts of these tests, including what is measured in each part.

The CBC, with Diff,/with Plt:

In plain English, this test measures the concentration of white blood cells (WBC), red blood cells (RBC), and platelets (PLAT) in the blood.  All are important since the white blood cells make up your immune system, the red ones carry oxygen to the other cells in your body – so the higher the number here the better – and wastes such as carbon dioxide from them, and the platelets deal with the blood’s clotting ability by repairing leaks in your blood vessels.

Something I found interesting: white blood cells are the largest, red ones smaller and platelets the smallest and that there are five billion red blood cells – the mid sized cells – in a single drop of your blood .  Your blood is 60% plasma, which is a fluid, and 40% blood cells.  Remember the kidneys should control the amount of fluid in your body, but with CKD doesn’t do this effectively.

Furthermore, red blood cells usually live 120 days, but not with CKD so they need to be replaced more often.  You may not yet have heard of EPO (erythropoietin). This is the substance that travels via the blood from the kidneys to the bone marrow to trigger the manufacture of red blood cells.  With CKD, less EPO is produced so the bone marrow makes fewer red blood cells.  That translates into anemia. 

“DIFF.” indicates that your doctor wants the lab to describe each type of white blood cell and list how many of each type of cell is present since each performs a different function. Lymphocytes, monocytes, basophils, eosinophils and neutrophils (segmented means mature) are different types of white blood cells. Absolute means that a formula has been used to count each type of white blood cell.

Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.  I didn’t know it then, but hemoglobin is important for CKD patients. Hematocrit reflects the percentage of blood volume that is made up of red blood cells (erythrocytes), something else that is important to CKD patients.

MCV, or Mean Corpuscular Volume, measures the average volume or size of individual red blood cells. MCH, or Mean Corpuscular Hemoglobin, measures the hemoglobin content of red blood cells. MCHC, or Mean Corpuscular Hemoglobin Concentration, measures the concentration of hemoglobin in the average red blood cell. MPV, or Mean Platelet Volume, describes the size of the platelets. RDW is the red cell distribution width, also important for CKD patients since it deals with different kinds of anemia.

My explanation of the tests is a bit simplistic, but for me on this blood test, none of the results (column 2) were out of range (column 3) according to the reference ranges (column 4). This was good news for me.

 Most labs set up their reports using this four column system.  Column 1 was the name of the test.  I’ve learned to watch hemoglobin and hematocrit. It’ll be a little vague now, (all right, so it’s a little boring, too) but both have to do with anemia which can be common in people with our disease.

Amylase, Lipase

I glossed over the next section, since all was all right in my amylase – lipase world. Naturally, I had no idea what they were and didn’t care since they weren’t causing a problem for me.  But then curiosity got the better of me, so I looked them up: amylase is an enzyme that breaks starch down into sugar. Were we looking for diabetes, another cause of Chronic Kidney Disease, here?

 Lipase is an enzyme necessary for the absorption and digestion of nutrients in the intestines. I wasn’t sure why that was being tested until I researched a bit more and discovered that, even though an elevated level of this indicates a pancreatic problem, a mild increase of lipase in the blood could be an indication of kidney disease. Both tests were within range.  More good news for me.

Lipid Panel

Then I hit the Lipid Panel. Uh-oh, all these years of taking medication to successfully control my cholesterol level and the triglyceride number was out of range. These quarterly blood tests were to monitor the cholesterol lowering medication’s affect on my liver. I’d never had such a result before.  The triglycerides are one of the “bad” cholesterols like LDL cholesterol and could affect the heart and blood vessels. I was a little confused as to what this had to do with CDK.

Cholesterol, as you probably already know, is a natural substance in the body which is actually helpful – unless you have too much.  Then it threatens your heart health. Triglycerides, another natural substance in the body, can also threaten your heart health, this time via your coronary arteries. To be blunt, triglycerides are fat.

 I recognized HDL cholesterol as the “good” cholesterol and LDL as the “bad,” but what was VLDL Cholesterol? I discovered it’s “very low density lipoprotein,” a transporter of cholesterol within the body just like HDL and LDL cholesterol. I didn’t bother with ratios and percentages thinking (hoping?) they were self explanatory.

 

Comprehensive Metabolic Panel

It got worse: while my glucose (sugar in the blood), urea nitrogen (BUN) – which could indicate some kind of kidney disorder – and creatinine (a higher result could mean the kidneys were not adequately filtering this from the blood) were within range, the estimated GFR or Glomerular Filtration Rate was certainly not above 60 as it should be. The GFR is considered the best method measuring kidney function and staging of kidney disease. 

It is also important since the dosage of any medication you may be taking may have to be adjusted for this level of kidney function. Many drugs exit via the kidneys.  That means if your kidney function is reduced, these drugs are going further than they need to and you may need to take less of them.

 The percentage of kidney function is measured by comparing the amount of waste produced in your urine to the amount of waste found in your blood stream. To be perfectly clear, this test showed that my kidneys were functioning at a Stage 2 Kidney Disease Level.  Panic time for me!

Sodium, potassium, chloride, phosphate, calcium, magnesium and carbon dioxide are all electrolytes that the kidneys help keep in balance… and, according to this blood test, were. Suffice it to say, the anion gap deals with the body’s acidity. At this point, I decided the rest of the Comprehensive Metabolic Panel was just too technical for me. But the not knowing was probably worse than the knowing, so I forced myself to investigate them.

Protein, Total looks for an indication of kidney (I was right to research this) or liver function. Albumin, produced in the liver, deals with a certain pressure between blood and tissue fluids. Globulin was being tested for any degenerative, inflammatory and infectious processes (like CKD?).

I was beginning to feel I was re-inventing the wheel, but knew I was still a little too fragile to understand what the doctor was explaining, even if I did take notes. Again, I ignored ratios, deciding I could always get to that on the next round of tests if they turned out to be important, in range or not.

Calcium is more than we were told it is as children.  Yes, it does relate to bone metabolism, but it also deals with muscle contraction to name only one of its several jobs. It helps with trauma, infection and stress, too.

Alkaline phosphatase, if elevated, indicates a liver, bone or intestinal problem, possibly cancer. Alt and Ast meant nothing to me but, again, were tests to indicate liver damage or dysfunction. Bilirubin, Total is the test to see just how much of it from damaged or old, dead red cells remained in the blood when the hemoglobin broke down.

There’s far more to explain about this blood test even before we get to the urine test, but it will have to wait.  The material, while simplified, is too technical to absorb too much at one reading, so: more next time.  Have a fun, healthy weekend!

 

 

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