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Nephrology/37 yr old male with eGFR of 75

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QUESTION: Hello,

I went through some test results for my husband and since 2009 to present, tested 2x a year his eGFR has been between 72-78 (range >60). I have read that at his age of 37 his eGFR should be 110.

All his other lab results are in normal range. Creatinine is normal, no protein in urine, BUN normal, etc.

How concerning is this? Some articles state he has stage 1 kidney damage?? And the eGFR also declines with age. Is he eventually going to have chronic kidney failure when he is in his 60s or 70s?

We are very concerned.  Thank you

ANSWER: Ms. Walker,

Thanks for your question on Allexperts.

Not all people will have a GFR of 110 ml/min. Also, after the third decade of life, GFR reduces by 1 ml/min per year in normal people. I would not be too worked up about the eGFR value as long as his S.Creatinine is within normal range.

However, to put your fears to rest, ask his primary care physician to order a 24 hour creatinine clearance.

Sincerely,

Dr. Shah

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply.

So if he is close to 40 yrs old now and his egfr is near 70 does this mean when he is 60 yrs old he will have a egfr of 50 which means he will have kidney failure??

Please advise. Thank you.

Answer
Thanks for following up with me.

In the last decade a new paradigm has been introduced in which the true or measured GFR is estimated (eGFR) by formulas based on serum creatinine levels and in which these estimates are applied to the diagnoses of chronic kidney disease (CKD) in the general population. These criteria for diagnosis of CKD include an absolute threshold for eGFR, unadjusted for the effects of age on the normal values for eGFR. A consequence of these criteria has been to overstate the frequency of CKD in the general population and to generate many “false positive” diagnoses of CKD.

Thus, the conclusion is that GFR slowly decreases with ageing as a normal biological phenomenon linked to cellular and organ senescence, and that a low GFR in an elderly person, compared to the value found in a youthful person, is not necessarily a manifestation of a specific disease. This is not to say that specific diseases cannot be superimposed on the normal ageing process and thereby influence the rate of decline in GFR seen in individual patients.

Sincerely,

Dr. Shah

Nephrology

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Dr. Shamik Shah, MD, DNB (Nephrology), ISN Fellow

Expertise

I can answer all questions related to kidney diseases, hypertension, plasmapheresis and kidney transplantation. I am an Indian-Board certified Nephrologist. I was a post-Doctoral Scholar at the Division of Nephrology & Hypertension,Department of Medicine, University of California, San Diego. My area of interest is Critical care Nephrology and Acute Kidney Injury.

Please mention the units in which your lab results were reported and the normal reference range for your laboratory.


Alternative Website
http://www.syndeohealth.com/doctors/shamik-shah/91

Experience

Ten years as a Critical Care & Transplant Nephrologist

Organizations
International Society of Nephrology
Indian Society of Nephrology
Indian Medical Association
European Renal Association


Publications
- Shah SH, Cerda J. Acute Tubular Necrosis; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4, pp. 191-198
- Shah SH, Cerda J. Management of Acute Kidney Injury; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4
- Cerda J, Tolwani A, Shah SH, Ronco C. Continuous Renal Replacement Therapies in Modeling and Control of Dialysis Systems edited by Azar AT, Springer-Verlag, Heidelberg, Germany (In Press)
- Shah SH, Cerda J, Kellum JA. Acute Kidney Injury in Special Circumstances. John Kellum, Jorge Cerda, eds. Renal and Metabolic Disorders, Oxford University Press (In press)
- Shah SH, Mehta RL. “Anticoagulation in CRRT: Is Citrate better?”; Vineet Nayyar Ed. Critical Care Update 2009, Jaypee Brothers (In press)
- Shah SH, Mehta RL. “Non-dialytic management of acute kidney disease”; Evidence based Nephrology, BMJ, (In press)
- Shah SH, Mehta RL. “Epidemiology of Community-acquired AKI”; Ronco C, Bellomo R, Kellum J Eds. Critical Care Nephrology, Saunders. ISBN 1-4160-4252-0
- Abdeen O, Shah SH, Mehta RL; “Dialysis therapies in the surgical intensive care unit”; William Wilson, Christopher Grande, David Hoyt Eds. Trauma: Resuscitation, Anesthesia, and Critical Care, Informa Healthcare, NY 2007. ISBN 0-8247-2920-X
- Shah SH, Mehta RL. Acute kidney injury in critical care: time for a paradigm shift? Curr Opin Nephrol Hypertens. 2006 Nov;15(6):561-5.
- Shah, SH, Soroko S, Lischer E, Mehta RL. Delivered vs. Prescribed dose of Dialysis in Hospitalized Patients: Results of an Audit. J Am Soc Nephrol 17(Abstracts Issue): 2006, 107A.
- Shah SH et al “Biochemical Nutritional Parameters in Non-vegetarian and Vegetarian CAPD patients” Perit Dial Int 2001; 21 Suppl 2: S1-182


Education/Credentials
MBBS, MD (Internal Medicine), Diplomate of National board (Nephrology), ISN Fellow

Awards and Honors
Educational Ambassador of the International Society of Nephrology 2010
Fellowship of the International Society of Nephrology 2005.
Young Investigator Award by the International Society of Peritoneal Dialysis 2001

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