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Depression and Heart Disease

Kidney Disease: Understanding Your Lab Values

hi welcome to a chronic kidney disease
program at University of California San Diego my name is Danuta Trzebinska
and I’m a nephrologist in our clinic in this module we’ll talk about laboratory
values for chronic kidney disease it is important that you track and understand
your lab values we already talked about creatinine in the previous module
creatinine is a waste product from the muscle which is normally removed by the
kidneys the level in the blood rises when kidneys do not function well GFR or
glomerular filtration rate is calculated based on your creatinine and it
estimates percent of normal kidney function blood urea nitrogen also known
as BUN or some patients like to call it bun it’s a waste product from dietary
protein which is removed by the kidneys BUN or bun is also used to estimate the
level of kidney function but it is less reliable than creatinine it can be
affected by how much fluid one drinks and some other variables so we prefer to
focus more on creatinine let’s move on to electrolytes and acid-base balance in
the blood most people know that too much sodium is not good for you unfortunately
the level of sodium in the blood does not reflect how much sodium you’re
eating you might be eating three times as much as you should as an average
American does yet your measured level will remain normal at the expense of
drinking more fluid to dilute this extra sodium and possibly elevating your blood
pressure and putting extra strain on your heart some people can however
develop abnormal level of sodium in the blood
due to either poorly functioning heart or kidneys or liver or some hormonal
disturbances normal level of sodium is between 135 and 145 potassium is a
mineral in your blood that helps your heart and muscles work properly if the
level is too high it can change your heartbeat and lead to potentially
dangerous arrhythmia normal range is between three point five to five point
one if potassium level in your blood gets to be too high we’ll educate you
how to avoid foods which are high in potassium and use medications to help
maintain healthy potassium level now bicarbonate bicarbonate is a measure of
acidity of your blood patients with chronic kidney disease often cannot
excrete acid generated from metabolism of foods that they ingest mainly it
comes from protein and they develop metabolic acidosis
so what metabolic acidosis big deal right well it is a big deal metabolic
acidosis also known as too much acid or too little base can lead to muscle
breakdown no one wants to have weak muscle right it can also lead to weak
bones and it can speed up the progression of chronic kidney disease
normal value for bicarbonate is between 22 and 29 if your level is below that
your nephrologist might prescribe baking soda or similar
type of medication to correct it to neutralize extra acid in your body and
thus protect your muscle protect your bones and slow down the progression of
chronic kidney disease the next three laboratory values have to do with bone
health they can be are adversely affected by kidney disease and lead to
weak bones calcium and phosphorus are important for
strong bones abnormal levels of calcium and phosphorus
besides leading to bone disease believe it or not they can get deposited in your
blood vessels heart and other organs and cause damage as well normal levels for
those minerals might slightly vary depending on the laboratory but usually
our eight point six to ten point five milligrams per deciliter for calcium and
two point seven to four point five for phosphorus we will help you maintain
normal calcium and normal phosphorus levels with appropriate diet and if
needed we use some medications now parathyroid hormone also known as PTH
and not to be confused with thyroid hormone or TSH this is something
different so PTH regulates movement of calcium and
phosphorus between your blood bones and also affects the excretion in the urine
the acceptable level for PTH depends on the stage of kidney disease so you will
have to check with your doctor what’s the appropriate level for you if your
PTH gets to be too high will prescribe special type of vitamin D which will
bring it down to more healthy levels we are moving on now to laboratory values
for anaemia hemoglobin is part of red blood cells that carries oxygen from
your lungs to all parts of the body hemoglobin is used to diagnose anemia
the target range for hemoglobin in patients with CKD is somewhere between
nine point five to eleven and it’s kind of a moving target but for now this is
what it is if your hemoglobin level is below this
range your doctorate might prescribe special medication that will help you
your body produce more blood we also periodically measure your iron stores
iron stores are very important iron is a necessary building block for
red blood cells should you be iron deficient your doctor will likely
prescribe either iron pills or intravenous infusion to correct this
deficiency let’s talk about cholesterol for a moment everyone knows about
cholesterol right cholesterol is a fat like substance that
is found in all cells of the body your body certainly needs some cholesterol
but if present in excess it can lead to heart disease normal cholesterol level
is considered to be under 200 there are two basic types of cholesterol HDL also
known as good cholesterol you get a smiley face for this it has protective
properties to the heart so you want this number pretty high one of the ways to
increase HDL is by exercise and we’ll talk about this more LDL also known as
bad cholesterol does not get a smiley face it can contribute to heart disease
so you want this number on a lower side your doctor might ask you to take
cholesterol medication even if your level of cholesterol is under 200 so
normal right there is the reason is that patients with CKD
are at high risk for heart disease regardless of cholesterol level as I
mentioned in the previous module protecting your heart is our number-one
priority yes we’re kidney doctors yes we care
about kidneys but heart comes first a triglyceride is another type of fat
found in your blood and if elevated it might increase your risk of heart
disease it’s usually measured at the same time as measure cholesterol we are
now down going over various blood tests and are ready to focus on testing of the
urine in the normal state of kidney health
there should be no blood no protein and no bacteria in the urine nothing like
that presence of blood or protein cannot be
detected with a naked eye that’s why we asked you to submit urine sample to the
lab for a more precise microscopic measurements if your kidneys are
spilling protein in the urine we’ll run an extra test to quantify how much
protein is being wasted protein in the urine also known as proteinuria if you
want to sound like a nephrologist can overtime cause damage to your kidneys
whenever possible we use medications to decrease the amount of protein in the
urine and to protect your kidneys besides checking blood and urine tests
your nephrologist will likely want to have a picture of your kidneys this is
done to make sure that you have two kidneys yes some people are born with
just one kidney and they don’t know about this it’s an incidental finding
and we also want to make sure that there is no obstruction or abnormal cysts in
your kidneys depending on your situation your you might be asked to do either a
kidney ultrasound which is pretty simple or a little bit more sophisticated tests
like cat scan or even MRI let’s do two questions to test your understanding of
this module question number one what blood tests do we use to estimate level
of kidney function or GFR is it a sodium or B potassium or C creatine or D
phosphorus all right let’s think about this for a second
and the correct answer is C or creatinine creatinine is use to
calculate GFR all right are you guys ready for question number two how much
protein should be present in the urine option a none option B some but not too
much and let’s see option C the more the better all right
which one is it okay and the correct answer is that there should be
absolutely no protein in the urine protein in the urine is a risk factor
for worsening kidney function over time we do everything we can to minimize the
amount of protein in the urine congratulations you have completed the
module on laboratory values for chronic kidney disease please check our website
for additional educational modules on kidney health

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