My doctor told me I have kidney failure. Is this true?

I have been seeing a trend lately in the diagnosis of "third stage kidney failure". Kidney failure is a really significant diagnosis to give someone and should only be done so with the right kind of diagnostic perusal. One of my patients recently told me another PCP diagnosed him as having kidney faiilure. He decided to "make changes" and he healed himself. It is more likey he had dehydration as opposed to kidney failure, becuase true kidney failure is a lot of work to reverse--if at all, in my professional experience. It tends to be associated with diabetes and leads patients on a path to dialysis.

Kidney function is screened in basic blood panel work-ups. Within a kidney panel are tests such as calcium, potassium, sodium, carbon dioxide, glucose, albumin, phosphorus, creatinine, and glomerular filtration rate (GFR). Within these tests, the physician's eye will gravitate to the GFR first becuase it gives a very direct idea as to how well (or un-well) the kidneys are able to do their main job of filtering waste.

Specificially, the GFR is a measure of how well the kidneys are filtering the waste product creatinine. Creatinine is a metabolic by-product of muscle contraction, and must be excreted in the urine so its levels do not become toxic in the blood.

The GFR can change with kidney disease--this is true. However, it can also change with chronic dehydration and shock. Commonly, what I see is that physicains do not ask the patient questions that relate to hydation status, such as "Are you drinking water?" or, "Do you consume caffeine?" Even some medications can affect how the body can maintain hydration which can be reflected in the GFR levels.

The right way to diagnose kidney disease or failure is to use the GFR as a guide--not as an absolute. The physician must follow up with further urine tests (or even a kidney biopsy if indicated for more serious conditions) that includes:

• urine protein

• 24 hour urine protein

• glucose

• genetic testing

• autoimmune profiling

The urine protein is the most important to start with. If kidney disease is starting or has started, then there will be shifted levels of proteins in the urine (proteins should not be present in urine). There are different urine protein types with different markers evaluated. The choice of test would be a clinical decision on behalf of your provider, depending on your individual history.