David,
I suppose we should be calculating GFR. If you apply the abbreviated
MDRD the you get an estimated GFR of 56 mL/min/1.73 m2 for this patient.
Obviously bias from the MDRD creatinine value will impact on this
figure. If this is a close approximation to her GFR then what does it
mean? In a person with 2 kidneys this would be an eGFR that would
initiate some activity be classed as moderate renal impairment or Stage
3 disease under the KDOQI definitions. However having only half the
number of nephrons some elevation of creatinine of the patients might be
expected post-operatively. The question is whether there are any issues
with the remaining kidney or whether this just reflects reduced
capacity? In non-diseased kidney donors the remaining kidney starts to
compensate fairly rapidly. One study I seem to remember demonstrated
that after an initial fall in GFR post operatively to about 50-60% of
the pre-operative GFR, a rapid rise follows in GFR to as much as 75% of
pre-op GFR at 3 months. A question arises in the case of your patient
is why was kidney removed? Was it to deal with a pathological process
also affecting the remaining kidney. Therefore need to assess blood
pressure, look for proteinuria and haematuria and monitor eGFR. Would
suggest looking at any previous creatinines calculating the eGFRs and
seeing whether it is falling or rising.
Regards
Bill
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Williams David G
(RLN) City Hospitals Sunderland - Clinical Scientist
Sent: 24 January 2006 18:04
To: [log in to unmask]
Subject: Reference ranges for one kidney?
This one from a local GP - 27 YO female with one kidney (other removed
surgically) has a UTI and a creatinine of 109 umol/L, (slightly
elevated), urea 4.5 mmol/L, weight 70 Kg.
His concern is about the creatinine.
Is the reference range for urea, creatinine etc different in persons
with one functioning kidney?
David G Williams
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