do I need to see a nephrologist?

[Lazza1]

Hi.  I am a 57 y.o. male and I discovered my eGFR is 58.  My new primary care physician wants me to get checked again in a month and if my eGFR doesn't pop to 60 or above she wants to refer me to a nephrologist.  After I left her office I dug through all my prior lab test results and discovered that for the past 21 years (yes, since 1993) my creatinine level has always been about 1.3 - 1.4 (the best was 1.26 two years ago, the latest result showed 1.34) and eGFR ranged between 56 (last year) and 62 (some twenty years ago).  And so it seems my kidney function has always been borderline stage 2/3 chronic kidney disease.  My condition hasn't really deteriorated since my mid-30s, and I don't have any kidney disease symptoms.  My diet is excellent, I am not diabetic, I don't have high blood pressure, and I don't take any prescription meds or even much NSAIDs.

I sense that going to a nephrologist and take more tests would likely be a waste of money.  I'd rather only go if my eGFR dropped to 50 (or below).

Am I being sensible or should I listen to my primary care physician?


_Lazza

[Lazza1]

Well I went and got more blood work done.  I was told my results were now "near normal" and there is no need to see a nephrologist.  Since my eGFR was 58 before it probably popped up to 59, which really isn't a statistically significant change.  But it's enough for my doctor to just say drink more water and I'll see you next year.


_Lazza


PS - this time before the blood work I made extra sure I was well hydrated.  It might have helped!

[Lazza1]

Thank you for your response!  As for symptoms, I have none ... or at least nothing I would associate with kidney problems.  The only thing close are symptoms from an enlarged prostate, something I have been dealing with for 15 years (.. I am not on any medication for this).  Oh, I do see that sleep difficulties might be a symptom.  I have suffered from intermittent sleep since forever.

Again, I really don't want to go through unnecessary extensive (and expensive!) tests.  I still find it hard to imagine that after having stable (, albeit somewhat deficient,) kidney function for 20 years that there is now a need to see a nephrologist.


_Lazza

[Dr Santos]

Hi Lazza,
What are the symptoms present? I understand your concern regarding this and I agree with your attending physician that a repeat test may be necessary  and depending on the results, a referral to a nephrologist may need to be done. Chronic kidney disease slowly gets worse over months or years and loss of kidney function may be so slow that you do not have symptoms until  the kidneys have almost stopped working. It is important to prevent the final stage of chronic kidney disease or end-stage renal disease (ESRD). It is best that you check with the specialist for proper management. Take care and do keep us posted.