The Estimated GFR

There’s something I need to tell you: the state of Arizona has decided that transplants (not just kidney transplants) are elective surgery.  There we have our first death panel.  The state health insurance for lower income families has been instructed to deny claims for transplants, even reverse those claims already approved.  This is very, very scarey. I urge you to contact Jan Brewer, Arizona’s state governor, to protest BEFORE this kind of insanity spreads to other states.

Arizona is setting a precedent, one it would behoove us to insist she reverse.  The following link will give you a bit more information: http://ktar.com/?sid=1341224&nid=6.  Brewer’s contact information is at http://azgovernor.gov/Contact.asp.  There’s an e-mail form, a telephone number, a fax number and a snail mail address on that page. As Chronic Kidney Disease – Early Stage patients, we are far away from transplants, but we will need them whether it’s months, years or decades from now.

That’s the other end of our disase.  Now back to the beginning. The symptoms of kidney disease don’t show up until you’ve lost most of your kidney function.  That’s when you’ll experience the fatigue that’s not always a result of anemia, the muscle cramps that usually – but not always – present themselves in your calves, nausea, vomiting, appetite loss, easy bruising, itching and the shortness of breath when you exert yourself.  If you’re like me, you started feeling them as soon as you read about them, but they weren’t really there.  It was a classic case of medical student syndrome. That’s when you are convinced you have the disease (or, in my case, the symptoms) as soon as you learn about it.  Actually, according to my nephrologist, I’m probably at least 20 years away from such symptoms.  So how do the doctors know I have CKD?

It’s all in the numbers, the numbers of your estimated GRF that is. But what is the GRF, and why is it estimated?  Isn’t medicine an exact science? It seems not.

GRF means the Glomerular Filtration Rate.  Big help, isn’t it? Filtration Rate sounds easy enough, but what are (is?) a Glomerular?  The dictionary tells us that filtrate is the part of a liquid that passed through a filter. So, glomerular filtration measures the filtrate from the glomerular.

According to The Gale Encyclopedia of Medicine, a glomerular is a small tuft of blood capillaries in the kidney responsible for filtering out waste products. So far, so good.  Now, how does this relate to CKD?

It is considered the best indication of measuring kidney function when used as part of a formula that includes age, gender, body size, race and serum creatinine level. Creatinine is a waste product of muscle activity. What actually happens is that our bodies use protein to build muscles and repair themselves. This used protein becomes an amino acid which enters the blood and ends up in the liver where it is once again changed.  This time it’s changed into urea which goes through the kidneys into the urine.

The harder the muscles work, the more creatinine that is produced and carried by the blood to the kidneys where it also enters the urine.  This in itself is not toxic, but measuring the urea and creatinine shows the level of the clearance of the harmful toxins the body does produce.  These harmful toxins do build up if not voided until a certain level is reached which can make us ill. Working kidneys filter this creatinine from your blood.  When the blood levels of creatinine rise, you know your kidneys are slowing down.  During my research, I discovered that a non-CKD patient’s blood is cleaned about 35 times a day. A CKD patient’s blood is cleaned progressively fewer times a day depending upon the stage of the patient’s disease.

In Kathryn Seidick’s Or You Can Let Him Go, she quotes her son’s doctor, “The word you will come to love or dread, Mr. and Mrs. Seidick, is creatinine.  This is a substance constantly secreted by muscles, and its presence in the blood shows better than anything how well the kidney is doing.  If the creatinine is low, 0.5 to 1.5, the kidney is doing well; if it is high, the kidney is in trouble.”  This book was published in 1984, but Dr. Gruskin’s words are still apt, although he was referring to a child’s creatinine levels. A mature man’s can be between 0.6 to 1.2, and a mature woman’s between 0.5 and 1.0. It can be even lower for children and, as you age, it lowers even more.  The more websites I visited, the more variable [albeit very slight] I noticed in acceptable ranges for non-CKD creatinine levels.

Once again, I urge you to contact Jan Brewer’s office before our kidneys give out on us.  Thanksgiving is Thursday.  One of the things we can be thankful for is that we don’t need transplants yet, but what about those lower income people in Arizona who do need an organ transplant?  Think about how to phrase your letter to Brewer as you eat your turkey and just keep loving your life – the way these people being denied their transplants love theirs.

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Published in: on November 23, 2010 at 4:33 pm  Leave a Comment  

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