February 8, 2011

By all indications, one of the necessary evils of dealing with any disease is the constant and consistent need for blood work.  To break it down to the simplest terms, blood work is often what is used to confirm or refute an initial diagnosis.  If the diagnosis is confirmed, then this will, inevitably, lead to many, many more needle sticks.  Of course, if the diagnosis is incorrect, then either more blood work is done to test for something else or the doctor is happy saying you don’t have such and such disease, and you are even happier because your arms, and the veins in your arms, will be spared from incessant poking and prodding.

Obviously, this was not the case with me 27 years ago when I was diagnosed with Diabetes.  Over the years, especially when I had been living with Diabetes for quite a while, additional blood tests were performed that began looking at my kidney function.

Those familiar with this blood work manifest know all too well that there is a whole slew of lab tests that can be run and are run quite frequently.  However, I am just going to concentrate on a few…creatinine, BUN, microalbumin and eGFR.

First off, creatinine…The blood creatinine level shows how well your kidneys are working. A high creatinine level may mean your kidneys are not working properly. The amount of creatinine in the blood depends partly on the amount of muscle tissue you have; men generally have higher creatinine levels than women.  For most people, the normal kidney function range is between 0.7 and 1.3 MG/DL (there may be a slight difference depending on the standards that your lab, clinic or hospital uses, which goes for more lab work).  For me, just about three years ago, my baseline was 1.7, which is just out of the normal range.  Over the last several years, this number has been steadily increasing into the 2’s and then into the 3’s.  Dr. Hoenig, whom you were introduced to in an earlier blog, once told me that once I was into the 4’s, then it would be time to be referred to the transplant team.  Early in 2010, I hit 4.2, and then went as high as 4.3.  It has come back down since, but, as much as I would hope, that doesn’t necessarily mean my kidneys are going to miraculously return to normal function.  Blood work this past Friday shows that my creatinine level is at 3.8.

A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine.  A BUN test is done to see how well your kidneys are working. If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher. Liver disease or damage can lower your BUN level.  A low BUN level can occur normally in the second or third trimester of pregnancy.  The normal range is about 8.9 to 20.6 MG/DL.  My BUN level has been close to 200 at one point.  With my most recent labs it is at 41.0 – still high.

A microalbumin test checks urine for the presence of a protein called albumin.  Albumin is normally found in the blood and filtered by the kidneys.  When the kidneys are working properly, albumin is not present in the urine. But when the kidneys are damaged, small amounts of albumin leak into the urine. This condition is called microalbuminuria.  Microalbuminuria is most often caused by kidney damage from Diabetes.  If early kidney damage is not treated, larger amounts of albumin and protein may leak into the urine. This condition is called macroalbuminuria or proteinuria.  When the kidneys spill protein, it can mean serious kidney damage is present. This can lead to chronic kidney disease.  The normal lab range is 0.0 to 29.0 UG/ML.  My lab result was 1064.0.

The eGFR (estimated Glomerular Filtration Rate) is a number based on your blood test for creatinine.  It tells how well your kidneys are working.  Essentially, as I understand it, it helps the doctor determine at what percent your kidneys are functioning.  With these most recent lab results, I am unchanged at 17%.  Dr. Hoenig has told me that dialysis typically begins when you hit 10% kidney function.  However, everyone is different and every case is different, so certain doctors may have differing philosophies of when to begin dialysis.

My thanks to the South Shore Medical Center website for helping to explain these tests.  I hope I made it easy to understand for you.

Our hope is, provided Tommy gets the final clearance, is to do the transplant before I get to 10% function…it can be a short distance between 17% and 10%...