Interpreting creatinine results for patient with kidney disease.

Patients with kidney disease often perceive that there are two figures that are significantly related, the association of creatinine (Cr) and glomerular filtration rate (GFR) including age. The normal range for Cr in adults is 0.6-1.2 mg/dl for males, and 0.5-1.1 mg/dl for females (mg/dl = mg %). But nowadays, the Nephrology Society around the world, including the Nephrology Society of Thailand, have turned to use GFR or eGFR to determine kidney function instead of Cr as it is easier to interpret preventive measures. Therefore, a good laboratory should always include the eGFR in the report.

In addition, the Nephrology Society of Thailand recommended that if the degeneration rate of GFR is greater than 7 cc per year, it is considered too soon degeneration.  You would need to see a doctor to identify the cause and fix it.

But in the future, whether the kidneys shall quickly or slowly deteriorate, it depends on self-care behavior with the following significant points.

1. Be as careful as possible not to increase blood pressure over 130/80 mm Hg.
2. If you have diabetes, you must always maintain the fasting sugar below 130. 
3. Avoid toxic substances for kidney, which are pain killer (NSAIDs), aminoglycoside antibiotics, and herbs as it can easily cause kidney dysfunction. 
4. You should refuse contrast material injection for special X-ray examinations except the case that the existing disease may cause death if it is not injected, then accept the injection, as these materials are toxic to kidneys.
5. Diet must not be salty, and contain enough calories (30-35 calories per kg per day) and optimal protein (0.6-0.8 grams per kg per day).
6. Don’t let yourself get dehydrated. Drink no less than two liters of water a day. By limiting the water, the kidneys will degenerate faster. Water restriction is performed only at the last stage when the body is swollen. 
7. Eat more fruits and vegetables. Don't restrict intake of potassium-rich food, vegetable, or fruits too much until it leads to vitamin deficiency. The restriction is limited to the final stage of the disease with an excessive potassium blood level which is considered end-stage renal disease requiring dialysis.
8. Do a moderate exercise for half an hour every day.  People with kidney disease often do not die of the kidney disease but die of heart disease or coronary heart disease. 
9. You should test for hepatitis B immunity blood test (Anti HBs) and get the flu vaccine once a year, every year. If you are over 65 years of age, pneumococcal vaccination should also be given, as all these three diseases are considered dangerous for chronic kidney patients.

For patients whose kidneys are not the same size, this is not unusual. But hematuria (blood in urine) is considered abnormal. If there is blood in urine without protein detected, this means that the filtration function still work well. The bleeding can be caused by various reasons as follows :

1. Kidney cysts. 
2. Urinary tract inflammation.
3. Urinary tract obstruction such as stones.
4. Bladder cancer or kidney cancer.
5. Easily bleed, a bleeding disorder, can be diagnosed in from various diseases.
6. Diseases that cause abnormally high calcium level in urine.  

From all these diseases, Bladder cancer is often the rarest but the most dangerous. There is a need to perform a cystoscopy to look inside the bladder.