The Stages et al

Here’s hoping everyone had a wonderful Thanksgiving and so much to be thankful for – so much, in fact, that you realized some lower income people in Arizona need their transplants so they can be just as thankful.  And that you’ve contacted Jan Brewer’s office to let her know that transplant is NOT elective surgery. It’s the oppposite of the death sentence she’s imposing on these people by refusing their transplants.

I’m going to jump back to early stage Chronic Kidney Disease now. DaVita has an estimated GFR calculator on its website at: http://www.davita.com/tools/gfr-calculator/#.  However, you will need your serum creatinine reading to use it. There is more information here that I cannot explain than I can since I’m not a medical professional. Basically, you enter your information and then a CKD stage comes up.  Try it if you’re willing to forego understanding the medical terminology.

I decided to trust that my doctor would understand the necessary formula, especially when I saw that mathematical formula, but decided to give the DaVita site calculator a try, too. Sure enough, using the information from my blood test for the creatinine, my information placed me at Stage 3 CKD.  When I lost weight, I was placed at Stage 2. It’s apparent that this may be the calibration system my doctor uses since it takes body weight into account.  There are many other systems that do the same thing. Just looking on the internet will give you an idea of how many and how they differ slightly from each other.

Notice the radio buttons asking if you are Afro-American. Not only are Afro-Americans at higher risk of CKD, but they have higher muscle mass, so the calculation result has to be multiplied by 1.2 for a true reading.  That struck me as odd, not the need to re-calculate, but that you can find a true reading for an estimated value.

In 2002, which is not all that long ago, CKD was divided into five stages by the National Kidney Foundation, dependent upon your GFR results. Serum creatinine is used in this formula as well as age, race and gender.  One of the jobs of the kidneys is to remove this muscle activity waste product from your blood.  The higher the levels of this in your blood, the lower the kidney function.

 Stage 1             90 ml/min or higher            normal or higher
 Stage 2             60-89 ml/min                        mild
 Stage 3            30-59 ml/min                        moderate
                       Stage 4            15-29 ml/min                         severe
                       Stage 5          less than 15 ml/min               end stage

CKD progresses slowly.  Using these divisions, your nephrologist knows how to treat your illness.  Each stage requires different treatment.  I’ll use Stage 2, the stage my tests show, as an example.  Usually, at this stage, there are no symptoms.  I found out I had CKD when I was being tested for liver function.  That’s how most people at this stage will be diagnosed: being tested for some other ailment.  The blood test I took included GFR estimated routinely.  It had never mattered before.  Such a test might show up more urea in the blood or, when the urine is tested, protein or blood in the urine.  Sometimes, a CAT scan, ultrasound, MRI or contrast X-ray may catch kidney damage.

Once diagnosed, you’ve got to continue monitoring the progress of this disease.  I take a blood test and give a random urine sample [that’s the pee in a cup kind] once a year and six months later, another blood test accompanied by a 24 hour urine test and give another random urine sample.  Other than that, at this early stage, I follow the renal diet, try (desperately in my case) to watch my weight including counting calories and exercising daily, whether I want to or not.  I should be trying to ingest the Dietary Reference Intake or DRI for vitamins and minerals, but find I often rely on my daily vitamin to do that.  If I were a smoker, I would have had to stop.  Come to think of it, I was a social smoker, but I think it wouldn’t be fair to tell you how easy it was to quit since I only smoked maybe a pack a month.

I am careful about my blood pressure.  Right now, my nephrologist and I, working as a team, are checking it twice a day.   That means he tells me to take a reading at 10 a.m. and before dinner at 6 p.m. daily with my home blood pressure equipment and I do it.  I found my equipment right in the pharmacy and was surprised that it was both a good brand and not too expensive.  I’ve noticed when I’m ill [UTI, flu, etc.], my blood pressure is higher.  When I’m not, it’s usually within range, which is about 130/85 for me since I have neither diabetes nor proteinuria.  The nephrologist and I are actually watching for low blood pressure since it was too low before my HBP medication was cut in half.

My nephrologist is treating me for one aspect of Stage 3.  It seems I’m not producing enough Vitamin D, so I now take more Vitamin D supplements.  I need this to insure that my bones and teeth remain strong.  But, then again, every time I take a blood test, something in my regime is changed because I’m either overloaded with whatever it is or not producing enough of whatever it is.  My nephew-in-law calls this my balancing act.  He’s right.  It is all about keeping in balance.

I know there’s no cure for CKD, but I’m becoming more and more confidant that I will be able to slow its progress for a long, long time.  Brag time: for the first time since I was diagnosed, all my blood tests came back normal.  The only downside to that is the test was for an infection which did show up in the urinalysis. I’m still in my positive mode, so I’m sure I’ll conquer that, too.

I’ll explain more about the renal diet in a later blog.

I’ll meet you back here on Tuesday once the manic Black Friday, which has now been extended to the whole weekend, is over.

Until then, keep loving your life!

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Published in: on November 26, 2010 at 7:02 pm  Leave a Comment  

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