If you have chronic kidney disease and your latest kidney blood test showed a lower GFR than the one before, that result is a question for your doctor, meaning the one who looks after your kidney disease. You cannot raise your GFR, but you can try to keep it from going lower. With your report in front of you, you can check what each of its two numbers describes, and you can bring your doctor the questions to ask before a day when nothing stays down.
What the two numbers on your kidney report describe
One of the two numbers on your kidney report shows how well your kidneys are filtering your blood, and the other shows whether a protein called albumin is passing into your urine. Providers check for kidney disease with a blood test called GFR, for glomerular filtration rate, and a urine test for albumin, and once you have kidney disease they use the same two tests to monitor it and make sure your treatment plan is working.
Your GFR is an estimate: providers use the amount of creatinine in your blood to work it out. Creatinine is a waste product from the normal breakdown of your muscles, your kidneys remove it from your blood, and as kidney disease gets worse, the level of creatinine goes up. Albumin is a protein found in your blood. A healthy kidney does not let albumin pass into the urine, a damaged kidney lets some pass, and the less albumin in your urine, the better. A provider can check for it with a dipstick, or with a urine albumin-to-creatinine ratio, or UACR, which measures and compares the amount of albumin with the amount of creatinine in your urine sample.
Among the result bands for these tests:
| Test | Result | What it means |
|---|---|---|
| GFR | 60 or more | in the normal range |
| GFR | less than 60 | may mean you have kidney disease |
| UACR | 30 mg/g or less | normal |
| UACR | more than 30 mg/g | may be a sign of kidney disease |
Talk with your doctor about what your specific numbers mean for you. If albumin turns up in your urine, your doctor may want you to repeat the urine test one or two more times to confirm the result.
Kidney disease tends to get worse over time, so each time you get checked, ask your doctor how the results compare to the last ones. The goals are to keep your GFR the same and to keep your urine albumin the same or lower. With a result lower than the one before, also ask whether your kidney disease is getting worse.
Is a day when nothing stays down different for you?
Vomiting is one of the causes of dehydration, the loss of too much fluid from the body, which happens when you lose more fluid than you take in and your body no longer has enough to work properly. You can become dehydrated because of:
- diarrhea
- vomiting
- sweating too much
- urinating too much, which can happen because of certain medicines and illnesses
- fever
- not drinking enough water or other fluids
Some people are more likely to become dehydrated, including people with chronic illnesses that cause them to urinate or sweat more often, such as diabetes, cystic fibrosis or kidney problems, and people who take medicines that cause them to urinate or sweat more. Ask your doctor whether your kidney disease, or any medicine you take, does that to you.
Acute kidney failure is the rapid loss, over less than 2 days, of your kidneys' ability to remove waste and help balance fluids and electrolytes in your body. There are many possible causes of kidney damage, and one is decreased blood flow due to very low blood pressure, which can result from burns, dehydration, hemorrhage, injury, septic shock, serious illness or surgery.
At its most severe, dehydration can be life-threatening, and you need medical help right away if signs of dehydration, such as feeling very thirsty, dark-colored urine or urinating less than usual, also include any one of these:
- confusion
- fainting
- lack of urination
- rapid heartbeat
- rapid breathing
- shock
Lack of urination, a rapid heartbeat, rapid breathing and shock are also signs of severe dehydration, and severe dehydration is a life-threatening emergency, so for any of those four, get to an emergency room now or call 911. For confusion or fainting, call 911: fainting is a brief loss of consciousness, and 911 is the number to call if you lose consciousness at any time, or if your alertness changes in any other way, such as confusion.
Contact your doctor's office right away, or seek medical care, if you have been unable to keep any fluids down for 12 hours or more, or have been vomiting for longer than 24 hours, and do the same if you have vomited 3 or more times in one day (see Can't keep fluids down for 12 hours? Contact a provider right away).
Watch the amount of urine you pass, too. If your urine output slows or stops, or you have other symptoms of acute kidney failure, contact your provider, and those other symptoms can include swelling in your legs, ankles or feet. When your urine slows, contact your doctor's office. When it stops altogether, that also means an emergency room or 911, because no urine at all is lack of urination, and urinating less than usual is itself a sign of dehydration.
Which everyday painkillers and cold remedies to ask about
The painkillers to ask about are the nonsteroidal anti-inflammatory drugs, or NSAIDs. Regular use of NSAIDs, such as ibuprofen and naproxen, can damage your kidneys, so be careful about the daily use of over-the-counter pain medicines, and ask your pharmacist, before you need one, which pain or fever medicine is safe for you on a sick day.
Cold and fever remedies can carry them too. If you take over-the-counter or prescription medicines for headaches, pain, fever or colds, you may be taking NSAIDs, which include commonly used pain relievers and cold medicines that can damage your kidneys and lead to acute kidney injury, especially in people with kidney disease, diabetes and high blood pressure. Fever is also a cause of dehydration, so a feverish sick day can bring the lost fluid and the cold remedy together.
NSAIDs are sold under many different brand names, so the name on a box may not tell you whether it holds one. Look for NSAIDs on the Drug Facts label of anything you buy over the counter, and ask your pharmacist or doctor whether the medicines you take are safe to use. Bring the boxes from your cupboard to the pharmacist on a day you are well, and ask which, if any, to stop using.
Medicines are a cause of acute kidney failure as well, including NSAIDs, certain antibiotics and blood pressure medicines, intravenous contrast dye, and some cancer and HIV medicines. Do not stop a prescribed medicine on that list without asking the doctor who prescribed it. Each time you pick up a prescription or buy a medicine or supplement over the counter, ask the pharmacist how the product may affect your kidneys and the other medicines you take. Filling your prescriptions at one pharmacy or pharmacy chain lets your pharmacist keep track of your medicines and supplements and check for harmful interactions.
What to agree with your doctor before a sick day
At a visit while you are well, agree with your doctor on how much to drink on a day you are sick and on whether any of your medicines change that day. Each person's fluid needs can be different, so ask your health care provider how much you should be drinking each day. Getting extra fluids when you are sick is the general advice, and when liquids will not stay down, you can try small sips of water or sucking on ice chips. If you have been told to limit fluids, ask the doctor who set the limit what it should be on a sick day, before you drink more than it allows.
Your doctor may change your medicines as your kidney disease gets worse, because kidneys that do not filter as well as they did can let medicines build up in the blood to unsafe levels, and some medicines can also harm the kidneys. You may be told to take a medicine less often or take a smaller dose, or to stop taking it or switch to a different one, so make none of those changes yourself on a sick day. Ask your doctor, "Do any of my medicines or doses need to be changed?", and then whether the answer is different on a day you cannot keep food or fluids down.
Other questions to ask at the same visit:
- Should I be looking for any symptoms? If so, what are they?
- What can I do to keep my disease from getting worse?
- When will I need to see a nephrologist, a kidney specialist?
If a primary care doctor looks after your kidney disease, they may refer you to a nephrologist if you have a complicated case of kidney disease, your kidney disease is quickly getting worse, or your kidney disease is advanced, so ask whether your new result puts you in any of those groups.
Keep an up-to-date list of everything you take, medicines and supplements alike, in your wallet, and take it, or all of your medicine bottles, to every health care visit. Someone you trust, a friend or a relative, can come along to take notes and help remember what the doctor said, so someone besides you has heard the plan before the sick day comes.
If NicoCares treats you, your kidney disease and the new result belong in the medical history a physician uses to make a clinical decision, so tell your care team about both through Spruce, where NicoCares messages are answered. NicoCares does not handle emergencies: on a sick day the signs above go to your doctor's office, an emergency room or 911, as each one says, and none of them waits on a message.
