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What Do My Pathology Reports Indicate?
Question: Dear Doctor, Is it possible to give an approximate estimation of the extent of kidney failure over a 3 day period on the basis of the following pathology results (the data for Day 3 is not as complete)?
DAY 1: urea 27.0 mmol/L; creatinine 173 umol/L; estimated GFR 34; sodium 146 mmol/L; potassium 3.3 mmol/L; magnesium 0.70 mmol/L; calcium 2.47 mmol/L; corrected calcium 2.63 mmol/L; phosphate 1.01 mmol/L; actual bicarbonate 32 mmol/L; venous bicarbonate 35 mmol/L; bicarbonate 34 mmol/L; base excess 8 mmol/L.
DAY 2: urea 30.9 mmol/L; creatinine 174 umol/L; estimated GFR 34; sodium 150 mmol/L; potassium 3.6 mmol/L; magnesium 0.73 mmol/L; calcium 2.35 mmol/L; corrected calcium 2.65 mmol/L; phosphate 1.12 mmol/L; bicarbonate 33 mmol/L
DAY 3: urea 34.0 mmol/L; creatinine 204 umol/L; estimated GFR 28; sodium 157 mmol/L; potassium 3.4 mmol/L; bicarbonate 30 mmol/L
It is obvious that the kidney failure is bad even on DAY 1. However, is there any evidence of a deterioration over the subsequent 2 days? If there is, could you please explain the reason for drawing this conclusion?
DAY 1: urea 27.0 mmol/L; creatinine 173 umol/L; estimated GFR 34; sodium 146 mmol/L; potassium 3.3 mmol/L; magnesium 0.70 mmol/L; calcium 2.47 mmol/L; corrected calcium 2.63 mmol/L; phosphate 1.01 mmol/L; actual bicarbonate 32 mmol/L; venous bicarbonate 35 mmol/L; bicarbonate 34 mmol/L; base excess 8 mmol/L.
DAY 2: urea 30.9 mmol/L; creatinine 174 umol/L; estimated GFR 34; sodium 150 mmol/L; potassium 3.6 mmol/L; magnesium 0.73 mmol/L; calcium 2.35 mmol/L; corrected calcium 2.65 mmol/L; phosphate 1.12 mmol/L; bicarbonate 33 mmol/L
DAY 3: urea 34.0 mmol/L; creatinine 204 umol/L; estimated GFR 28; sodium 157 mmol/L; potassium 3.4 mmol/L; bicarbonate 30 mmol/L
It is obvious that the kidney failure is bad even on DAY 1. However, is there any evidence of a deterioration over the subsequent 2 days? If there is, could you please explain the reason for drawing this conclusion?
Brief Answer:
Progressive kidney disease.
Detailed Answer:
Hi XXXXXXX
The reports shown by you indicate a progressive rise on day 3. the report to notice is serum creatinine and GFR tests.
Serum creatinine has risen from 173 on day one to 204 on day 3 . Creatinine is a waste product that accumulates in the blood once kidney is not able to through it out and we measure the level in blood.
The GFR which was 34 on day one is 28 on day 3 showing loss of 6ml Gfr over 3 days.
So kidney disease has worsened from day 1 to day 3, though it was already functioning less on day one ( 34% of normal)
Hope this clarifies your doubts.
Best wishes.
Progressive kidney disease.
Detailed Answer:
Hi XXXXXXX
The reports shown by you indicate a progressive rise on day 3. the report to notice is serum creatinine and GFR tests.
Serum creatinine has risen from 173 on day one to 204 on day 3 . Creatinine is a waste product that accumulates in the blood once kidney is not able to through it out and we measure the level in blood.
The GFR which was 34 on day one is 28 on day 3 showing loss of 6ml Gfr over 3 days.
So kidney disease has worsened from day 1 to day 3, though it was already functioning less on day one ( 34% of normal)
Hope this clarifies your doubts.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Bansal for sharing with me the expertise of your analysis. May I ask one last question? If the administration of frusemide were to cease because of a significant fall in BP, e.g. if the systolic fell to around 85 on DAY 3 then would it be normally contraindicated to continue to use NORMAL saline IV considering the high sodium level on DAY 3 (sodium 157 mmol/L) and the fact that the patient has kidney failure? Why? Thank you again for your analysis of the pathology data.
Brief Answer:
saline role in hypotension
Detailed Answer:
Frusemide- The job of this drug is to clear extra water from the body and it has nothing to do with improving or deteriorating the kidney function. It just helps to increase urine in decreased kidney function. It does not change creatinine level.
Hypotension or low BP- can occur due to infection, lack of water(volume) in body, cardiac dysfunction. Low BP like 85 systolic will definitely affect the kidney and cause worsening of kidney function.
Normal saline IS NOT CONTRAINDICATED in hypotension at any level of sodium. In Fact it is the drug of choice because it will replenish the body volume and improve BP. It will also bring the sodium level closer to normal in both high or low sodium level conditions.
Best wishes.
saline role in hypotension
Detailed Answer:
Frusemide- The job of this drug is to clear extra water from the body and it has nothing to do with improving or deteriorating the kidney function. It just helps to increase urine in decreased kidney function. It does not change creatinine level.
Hypotension or low BP- can occur due to infection, lack of water(volume) in body, cardiac dysfunction. Low BP like 85 systolic will definitely affect the kidney and cause worsening of kidney function.
Normal saline IS NOT CONTRAINDICATED in hypotension at any level of sodium. In Fact it is the drug of choice because it will replenish the body volume and improve BP. It will also bring the sodium level closer to normal in both high or low sodium level conditions.
Best wishes.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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