Goodness Friends Really (GFR) – where do we start talking about the GFR (Glomerular Filtration Rate)!
This is the standard way to estimate the competency of your kidneys, in particular their ability to filter waste from the blood. There is SO much to say and not quite enough attention span for most of us because renal stuff is silent, it’s not typically what patients write down on their forms as requiring your utmost urgent attention &, let’s be real, it only happens to old people, right? So wrong. Commonly reported as part of ELFTs or General Chemistry, of course it is only an estimation & it’s not infallible – the GFR can both under and over-estimate renal health depending on a number of confounders, however, putting that aside for another time, can we all just agree that renal risks are REAL, they are RIGHT NOW, (CKD won’t happen over night but for 1/3 it WILL happen) and they are REALLY REALLY not talked about enough, by most health practitioners?
Hmmmmmmmmmm… knowing how effective our kidneys are at removing waste is a pretty important insight to have about our whole health story and if we are truly aiming to practice preventatively then, this system has to come somewhere close to the top of the to do list! Essentially we are all aiming for a GFR >90 and the lower the actual result, the greater the renal impairment. CKD arguably begins with any value <90, although this is only regarded as ‘mild impairment’, that may well still be highly significant, if for example, your patient is only in their 30s! But conversations about this typically start when results drop under 60, at which point you are in CKD stage 3 = moderate impairment. Not yet time to put the patient’s name on the dialysis wait-list ….yet, however, the reduced ability to remove nitrogenous waste will not only hasten the progression to needing this but also potentially contribute to heavy metal accumulation and cognitive decline but increase cardiovascular mortality risk by up to 57% ! So today I have a bewildered mintie pose a very sensible question – check it out:
Q: “Ummmmm, I’m confused…one lab’s ref range is >59 and the other is >90….Rachel are they measuring in the same units? These ranges vary immensely. I am seeing a few patients with values in their 70’s from the first lab..does that mean I shouldn’t worry? Are we comparing apples and apples here, Rachel?”
A:”Ahhhh yes…no pears in here, I’m afraid, it’s just that the first lab has normalised declining renal function, their reference range is a bit like the lowest common disease denominator and the 2nd labs ref range is based on’healthy’. Which lens should we use?
I have a handy saying, (a slightly simplistic one admittedly), that goes ‘your GFR should be over 90 unless YOU are over 90′ (in truth, the average GFR in healthy individuals, can drop under this in our 70s) – but it makes it easy to remember which lens, as a holistic practitioner, I need to look through.
There’s a lot more to say about this but…at least we’ve started the conversation 🙂
Feel like you missed the kidney class in your undergraduate?? You’re not alone. Nutritional or naturopathic support for the kidneys tends to have been over-looked in our training and yet research suggests there is much in our tool kit that can make an enormous difference to this system, in particular, slowing the progression of chronic kidney disease in patients. In, Nutritional interventions in renal impairment – place & potency, Rachel talks about key evidence based interventions and also gives you the tools to identify the early pathology markers of renal impairment.