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  Sunday, 27 September 2015
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I am a 71 year old male. My serum creatinine recently rose to 1.4mg/dl (eGFR = 55.3ml/min) from 1.3mg/dl. My internist says that this means I am in stage 3 of chronic kidney disease (this is scary). He prescribed lisinopril, since my BP was 125/75 and he said it should be < 120 systolic. I am OK with that. My micro albumin test showed an albumin of 5mg/l and a urine creatinine of 175mg/dl, which is quite high. I am rather large, over 6 feet, exercise a lot, including weights, and I am more muscular than average. I have impaired fasting glucose, but my HbAIC is 5.5%. I was taught that muscular individuals have a higher serum creatinine, so I asked him if there is a more accurate way of determining GFR, and he said yes, but they didn’t do that anymore and just went by the serum creatinine. I went home and checked my medical records that I keep. At age 31, I had gross hematuria after a 3 mile run and got a complete renal workup for that. My creatinine then was 1.2mg/dl (eGFR at that age 80ml/min). Therefore they did a creatinine clearance test, with 24 hour urine which gave a GFR of 127ml/min. I suspect my GFR is now lower with age, but I doubt it is as low as 55. I don’t want to be my own doctor, but should I ask him to order a creatinine clearance test? A cystatin-C test? Should I see a nephrologist? I am very active and don't want to think about dialysis in my future. Sorry for the US units. I should have converted them for you. Thanks.

I would not be concerned about this level of kidney function provided that it does not continue to drop further. Your level of albuminuria when corrected for creatinine is consistent with microalbuminuria and in and of itself not a concern from a kidney perspective. In some people, this might indicate an increased risk of vascular disease especially in the context of hypertension, hypercholesterolemia or diabetes. The degree to which your kidney function fell since you were 31 also is not incompatible with aging alone.

Provided your blood pressure is well controlled (<140/90 by some guidelines <130/80 in others), provided the GFR remains relatively constant and provided there is no concern about a systemic disease, I would not pursue any further testing.

Dr. Jordan Weinstein
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