Welcome to the second of three-part series on what you need to know about chronic kidney disease.  In the first part of the series, I outlined how chronic kidney disease affects 37 million Americans.  What is even more concerning is that 9 in 1o do not know that they have chronic kidney disease.
In this episode we will go over:
  • What laboratory tests need to be ordered.
  • How to interpret your lab tests.
  • Questions you need to ask your healthcare provider.
  • Some ways to reduce your risk of developing chronic kidney disease.

What laboratory tests need to be ordered

The basic metabolic panel is one of the most common tests your healthcare provider orders on a routine basis. The basic metabolic panel usually measures the following parameters:

  • Serum sodium
  • Serum chloride
  • Serum carbon dioxide
  • Blood urea nitrogen
  • Serum creatinine
  • Anion gap
  • Serum glucose

How to interpret your laboratory tests

I often tell my patients, that the old adage “no news is good news” is not always true when it comes to your test results. If your healthcare provider offers a patient portal as part of their electronic medical record system (EMR), please be sure to sign up for this. This will allow you to access all your diagnostic tests.  Ideally, you should have a follow-up appointment with your healthcare provider to go over your laboratory tests especially if there are any abnormalities. But at times this may not be the case particularly during times such as this with the ongoing pandemic.

So here’s a quick lesson on how to review your basic metabolic panel when it comes to your kidney health:

  • Blood urea nitrogen (BUN)
  • Serum creatinine (Creat)
  • Serum carbon dioxide
  • Anion gap

First of all, every laboratory report has a normal range. The normal range is usually located in a column to the right of your reported values.

The blood urea nitrogen and creatinine provide information about the excreting capacity of your kidneys. Look at your values and make certain they are in the normal range. Ideally, you want them smack in the middle of the normal range and not toward the upper limit of normal.

If your BUN or creatinine- particularly the serum creatinine- is toward the upper limit of normal, then the next step is to examine what trend of your laboratory values have been. This is why again it is important to have access to the patient portal as you can easily take a look to see what the trend of your BUN and creatinine have been.

The serum carbon dioxide and the anion gap give an idea of the acidity of your blood. If the carbon dioxide is low and the anion gap is high it indicates that you have a lot of acid in your blood. This may be due to many reasons including kidney disease and uncontrolled diabetes, so be certain to contact your healthcare provider to review this immediately.


Questions you need to ask your healthcare provider

As I stated earlier, it is always ideal to schedule an appointment with your healthcare provider when you want to address any concerns. In my experience, I have found that a lot of misunderstandings can be averted simply by having a face to face conversation.

Here are a few questions you could ask your healthcare provider if you notice an abnormality in your kidney function

  • How long has this trend been going on?
  • Could these abnormal values be explained by any recent changes in your health such as a recent illness, any medications or a decrease in water intake, etc?
  • When would it be necessary to do repeat kidney function testing?
  • What additional tests are necessary?


Some ways to reduce your risk of developing chronic kidney disease

  • Avoid dehydration. Make sure that you are getting enough water. Unless you have been told to restrict your water intake by your healthcare provider you should make sure that you are drinking enough water. I often tell my patients that by the time you feel thirsty, you are dehydrated. Another good way to check and make sure you are not dehydrated is to check the color of your urine. If it is dark yellow then you are dehydrated. Your urine should ideally be lemon colored.
  • Review any diuretics that you are on with your healthcare provider. Sometimes your healthcare provider may place you on diuretics. Diuretics can dehydrate the kidneys and raise the serum creatinine. However, if you’re BUN is elevated it may be a time to have a conversation with your healthcare provider about how long you may need to be on diuretics or whether the dosage needs to be adjusted.
  • Avoid drugs that can affect your kidney function. One of the common drugs that affect kidney function is the group called NSAIDS nonsteroidal anti-inflammatory agents. Access to these drugs is so easy because these are available over the counter and used for fever and pain. If you have been told that you have poor kidney function, then avoiding common drugs such as NSAIDs is important. There are several other drugs so be sure to check with your pharmacist and your healthcare provider.
  • Get a gynecology or prostate check-up.  One of the causes of chronic kidney disease could be blockage caused by an obstruction in the urinary tract or reproductive system. If you have a gynecological evaluation and you are told you have an enlarged uterus or prostate, for instance, it may place pressure on your kidneys causing them to be enlarged. So be sure to have this evaluated.
  • Avoid exposure to environmental toxins. Some examples of environmental toxins are persistent organic pollutants (POPs), pesticides, cadmium, mercury, tobacco smoke. These toxins are present in common everyday items such as water, food, paints, solvents, air fresheners, perfumes, cosmetics, etc.  Try as much as possible to reduce exposure to toxins by becoming more aware of potential toxins in your environment. This may include increasing the intake of organic foods that have less pesticides, avoiding GMO products, using more natural body care products. Also avoiding nonstick cooking products.

In the final part of the series, I will go over

  • Steps you need to take if you have been diagnosed with chronic kidney disease.
  • When (or if)  you need to see a specialist.

To your health and wellbeing,