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Stages of renal failure and GFR


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#1 betty32506

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Posted 27 December 2008 - 01:33 PM

For the last 3 or so years I have ask my primary care doctor about the labs under GFR nonAmerican. Either he doesn't know or can't explain it so that I get it. It is as if it is not important. I have had several creatinine checks both as routine and in conjunction with Scans that require contrast. It has not been off enough to keep them from doing the contrast study. But it doesn't look good to me. So I finally put my thinking cap on for some quality Googling motivated by the general practitioner telling me I need to cut down on the Metformin because of kidney function.

Labs done early Dec had my creatinine level as 1.4 with the normal range of .4 to 1.4. Doesn't look all that bad. Then I started trying to find the meaning of the GFR which is based on the creatinine level. But that came out with a GFR of 39 which indicate stage III renal failure. Things don't look so good with that in mind.

I have tried to organize my thoughts to be somewhat meaningful and I just hope this comes across that way. I am 75 and have LADA (diabetes) for about 5 years and have maintained good control on orals. That is getting harder to do and Metformin is a vital part of the equation. I take Amaryl and Starlix. Because of the contrast scans are problems in that Metformin has to be stopped for those. I have tried to drop the Metformin and increase the other meds. Doesn't work and I don't want to do Plan B, probably insulin.

I have spent hours reading the Metformin site. I have read other resources but the following comments come from the Metformin site. It is not recommended for those over 70 because of renal problems. Effective dose is 1,500 mg with a max. does of 2,550. I have been taking 2,000 mg or 2,500 mg.

What level of concern should I have about this? In effect I am my own doctor. LOL Diabetes management I do expecting the general practitioner to watch for trouble spots, like creatinine and such. I'm not entirely faulting the doctor but this is an area that I know very little about. :blink:

I have been "diagnosed" with neuropathy, lupus, Raynaud's, gastroparesis, LADA (diabetes) Sjogren's, scleroderma none of which are bad enough to disable me. There are others that the doctor hedges on. But in view of what I read on this site it can take years to actually get a diagnosis.

We probably all are experts in some aspect of these problems. What can you tell me about renal failure or otherwise that you consider important? If you need more info on other labs, I have lots of labs and don't know which are the important ones. :unsure:

Thanks for your comments.
Betty 32506

#2 LisaBulman

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Posted 28 December 2008 - 04:38 AM

Hi Betty,

As with any disease there are many roadblocks, change in treatment plans and the ups and downs of not knowing what will happen next. As a patient you need to be educated and willing to make decisions for yourself. I have gone for many years without taking meds because I felt the side effects outweighed the progress or how I would feel.

With that said, if you feel that the Metformin is actually causing more harm than good you might really want to consider other options. Once one thing or system is out of whack it seems to have a snowball effect on everything else.

Here is our page on Kidney involvement
at www.sclero.org

Hugs,
Lisa
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#3 Buttons

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Posted 28 December 2008 - 10:19 AM

Hi Betty
Sorry to hear of the problems you are having but just wanted to tell you about my mum who is almost 83 was taking metformin for her diabetes for a about 8 years and she became very poorly mid August & was admitted to hospital & after tests it showed she was going into Kidney failure, fortunately they stopped the metformin immediately & treated her Kidney failure & she is now fine. She had not been eating very well for a long time because she said everything tasted dreadful & after coming off the metformin she now has got her sense of taste back & is much better. They have given her another diabetic tablet but it looks like it is not has effective because her sugar levels are very high, so it may be that she is has to go on insulin. They are now monitoring her diabetes very carefully.
I would say that it is a good thing being informed about the medication that we take and it is sometimes good to be cautious about some of the drugs that we are given.
It is so hard knowing what is best.

Hope things are sorted out for you soon.

#4 betty32506

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Posted 28 December 2008 - 11:27 AM

Hi Lisa,
Thanks for your response. One of the problems I see in this is that there are no symptoms and I have no way of feeling a problem. For sure one problem spills over to others. I always try for prevention when I can rather than treatment. I stayed off meds for probably close to 2 years to the extent that I cannot answer when someone ask how long I have been diabetic. But with the gastric problems I cannot do low carb diet.

#5 betty32506

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Posted 28 December 2008 - 11:37 AM

Jensue,
Thanks for telling me about your mum. I am surprised that the problem could be handled as well as it was. Interesting about the taste. That thought never entered into any of these thought process. But often something just doesn't taste right. We ate at a buffet yesterday and I had my husband tasting everything on my plate. It all was like if some unknown spice had been added to everything. That is another research area I will look into.
Betty

#6 Kamlesh

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Posted 28 December 2008 - 07:38 PM

Betty,

I take three prong approach in managing my diabetes.
1. Of course Metformin is a critical to force pancreas to generate insulin. I take 1000 mg which is down from 2000 mg I used to take couple of years ago.
2. I take actos which forces my cells to absorb sugar easily
3. Finally, I take small dose of Glipzide 5mg to provide some insulin

With this combination my A1C stays between 5.5 to 6 and morning glucose around 80-90.
Kind regards,

Kamlesh


#7 betty32506

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Posted 29 December 2008 - 06:57 PM

Did I ever have a fun day today! :wacko:
Today was not the day to need a doctor. I tried to call my doctor getting only the persistent busy signal. I then tried the walk in clinic. :rolleyes: Finally I was able to get in to an ER in a nearby town. After about 3 hours I finally progressed to the cubbyhole where I finally to see the doctor.

My feet/leg are really looking bad. The left is swollen the worst and is very red. They said I have cellulitis no comment about the right one that is swollen but not red. Also he would not talk about Metformin and/or kidney problems. They did some labs including createntin and that tested out to be 1.2 rather than the last check was 1.4 That still leaves it 3rd stage kidney failure. They did start me on antibiotics so I gained that anyway.
I am still in the dark as to knowing about the Metformin.

I wish I knew if taking very little amount of Metformin yesterday and today is responsible.

Also interestingly enough I learned that they do not know about the GFR so I guess my general practitioner is in good company when he doesn't know what that is.
Betty

#8 Shelley Ensz

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Posted 30 December 2008 - 11:56 AM

Betty, do you have a nephrologist on your medical team? It sounds to me like it would be a good idea to consult one, at least for one visit. They are trained in how to evaluate and manage kidney disorders.

Stage 3 kidney failure sounds horrible, I know, but usually there is a long way to go before hitting Stage 5. I've had creatinine of 1.4 before, but within a few years it went back down a bit. When creatinine hits about 20 is when the dialysis center usually starts putting you on their greeting card list.

But having someone on your medical team who (at the very least!) knows what a glomerular filtration rate (GFR) is, and who could possibly even answer questions regarding your medication issues, might be a very big relief.
Warm Hugs,

Shelley Ensz
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#9 betty32506

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Posted 30 December 2008 - 02:27 PM

Shelley,

Thanks for the reply. No, I do not have a nephrologist at all but until now nothing has come up that would make me even think such. If dialysis had not been mentioned here I probably would not have thought of dialysis. If I don't clear this up shortly I will see if I can see one without a referral. I'm peeved at my general practitioner and will push the limits before I see him again. We have been with him for many years and recently thinking of finding another. But it could well be that we would trade a known problem for an unknown. It was reassuring for Jensue to tell me about her mum. I'm glad you are better.

Did I say that yesterday a nurse asked me what the GFR was? She said they are just now putting that on their lab tests and the doctors don't know what it is. I think it would be high time for them learn The hospital should have that responsibility.

As for the creatinine = GFR that is dependent on age, gender and race. There is a GFR calculator that is neat to play around with, linked at Scleroderma Renal Crisis on the main sclero.org site. It looks like someone my age would have to have a .9 creatinine to be over 60. Boy the deck is stacked against the "elderly" :blink: .

I think I will just do the best I can with my sugar without the Metformin and then get another lab test. If no Metformin improved the test by .2 I will guess a couple weeks should be long enough to get it out of my system...hopefully :mellow:

#10 luvbnmom3

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Posted 06 January 2009 - 03:56 PM

Hi! I have run into the same thing with numerous physicians (Rheum, Internal Med., GYN, etc. & none of them know what the Kidney foundation has to say about the eGFR. It does say that normally you would have to lose 50% of your kidney function before your creatinine & eGFR were to be abnormal. It also says that we only need one kidney to function well, if one is doing great & the other is not, your labs could all look just fine. doctors always say, well, it's within the normal range & so is your BUN so you're fine. SO... I can tell you how things have gone with me & maybe it will give you a little more info... it isn't much though...lol.

My eGFR was 103.0 when I first started having all these health issues, that is PERFECT for me. Due to a variety of symptoms that kept coming, I ended up having a basic Chemistry panel done a number of times over a little more than a year. Each time, my eGFR was lower (& Creatinine higher) eventually landing at 69 eGFR! But when it was around 74, I decided to stop taking the NSAID I was on (even though rheumatologist said the steady drop wasn't a problem or related to the NSAID) it continued to drop down to 69. Six months after I stopped the NSAID my eGFR went back up to 89 but that is as high as it has gone. Healthy for my age is 103, 89 is still within a safe range, but a steady decline should have been a red flag to them....in my opinion.