This question was answered on Fri 19, Mar 2010 01:53am by Dr. Harsha Priolcar

Reasons for Decreasing eGFR?

    
Asked by angelkissed (Female; 38; UNITED STATES; 30 lb. unexplained weight loss, low normal weight (117 lbs.), low B12 (corrected with supplements), hypovitaminosis D (corrected with supplements), sudden increase in triglycerides (total, HDL and LDL all good), migraine, subclinical hypothyroidism in remission (no medication), left lateral neck mass (being investigated), normal BP, 20-year smoker (quit in 2007), moderate alcohol use (4 drinks/week), no drugs, severe MRI contrast allergic reaction (anaphylaxis/shock), no children or hormones ever; Relevant drugs:Topiramate 50 mg. (migraines), vitamins ) on Thu 18, Mar 2010 10:09am

Since July, my eGFR has steadily decreased. 59 (July), 59 (December), 57 (February), and now 54 (March). Labs reveal no proteinuria, hematuria, etc. No fever. No other signs of infection. No consistent urinary symptoms. Positive CVA tenderness sign in January, and achy (not colicky) pain for months above left flank area, though now decreased. Renal ultrasound was unremarkable aside from "moderately small" kidneys bilaterally (nephrologist said this was insignificant since I am small-framed). Urine albumin/creatinine was normal. My BMI is about 19. I haven't been exercising much at all due to not feeling well, do not consume excess protein, and have labs drawn fasting (as instructed). Nephrologist said, "It's not your kidneys." Then what is it? What could cause decreasing eGFR with this medical history and current clinical profile? Other labs are OK, but my PCP is somewhat indirect, and orders a comprehensive metabolic panel alone for almost everything. Sometimes lipids, urinalysis or CBC, but nothing specialized.

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Answer by Dr. Harsha Priolcar  on Fri 19, Mar 2010 01:53am:


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Comment by Dr.Ravindra Rajput on Fri 19, Mar 2010 06:39am:
Hi, Dr. Harsha Priolcar has ruled out all the causes for low eGFR and as well as explained quite well. Another important factor for low eGFR is volume depletion. If there is volume depleted state due to chronic dehydration, and if body compensatory mechanism is unable to retain the blood volume to normal level, can also lead to low eGFR. In such cases you need to take adequate fluids. Sometimes ultrasound may not detect other causes properly renal vein thrombosis, renal infarction and renal artery stenosis. In such cases color doppler and MRI will detect it with high precision. Any connective tissue disorder (SLE) if present should be ruled out. You also need to undergo blood tests like complete blood count, peripheral smear and ESR. And as Dr. Harsha Priolcar said, update your progress and we are there to help you. Take acre and regards.

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