Blood test indicates severe kidney damage

#MiddleburyCT #BloodTest #KidneyDamage

DEAR DR. ROACH: Last summer, a city policeman came to my door. My doctor had been unable to contact me with the results of a recent blood test and called the police. The policeman handed me a card with the results written on it. My creatinine level was 4.1, and my glomerular filtration rate (GFR) was 14. He said the numbers indicated that my kidneys were failing and that I should go to the emergency room immediately. Except for swelling in one ankle, I had no symptoms.

During a day and a half in the hospital, I lost 14 pounds of fluid after the insertion of a catheter. Within two weeks, my creatinine level was measured at 2.1. After a few months of wearing the catheter, my prostate was “trimmed back” (my words, not the doctor’s) using a procedure called a “TURP.” I am back to normal.

What is a TURP, and how routine is it? Are there any long-term negative effects? How close did I come to kidney failure? – T.J.R.

ANSWER: Your problem was obstruction of urine flow due to an enlarged prostate. The urethra (the tube that carries urine out of the body) goes right through the middle of the prostate, and an enlarged prostate can block flow partially or completely. This is a very common problem. Sometimes the urine flow stops entirely, but this doesn’t have to happen in order for kidney damage to occur. It’s the increased pressure in the bladder that causes damage.

Creatinine is an end product of protein metabolism, and since it is removed by the kidney, it’s a good indicator of kidney function. The higher the creatinine level, the worse the kidney function. The creatinine level (along with age and sex) are used to estimate the GFR, a direct statement of a person’s kidney function.

A (stable) GFR of less than 15 is considered stage 5 kidney failure, which usually means that dialysis will be necessary to preserve life. Note that creatinine itself isn’t the problem; it’s a marker for the fact that the kidney can’t remove all the other waste products, which will then build up and make a person very ill.

When a person with urinary obstruction develops a creatinine level over 6, it’s likely that they will have permanent kidney damage, but I have seen people with higher levels recover and some with lower levels experience permanent kidney function loss. My guess is that you were only a few days away from having permanent damage.

A trans-urethral resection of the prostate (TURP) is a traditional treatment for an enlarged prostate. Although newer treatments are often used in situations where there is plenty of time to spare, a TURP is a routine treatment for the type of obstruction you had. There are possible long-term side effects from a TURP, such as erectile dysfunction, but those are usually noticed immediately after surgery and often get better over time.

Finally, a plea: Make sure that your doctor has your up-to-date contact information, including your emergency contacts. We physicians are very grateful to have the police available for emergencies but would rather not have to use them. I try to remind my resident physicians to be sure that we have a working contact number any time we order a test, but it’s best if both the patient and physician have it on their lists. Even routine tests can occasionally come back with critical results.

Dr. Roach regrets he is unable to answer individual questions, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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