Low crcl; further investigation?

I was seen on the 19th for my follow up. I received a mostly good report. I am only being paced 7% in the atrium, but he still insists the pacemaker was an absolute necessity. I am having bouts of fast rates (somewhere in the 200 range), but am assuming it is a regular rhythm or not much he is concerned with as he still wants to hold off on meds.

This past weekend I was at a community fun day at the firehouse and had an episode. The heat most likely was the biggest factor, but I had drank plenty of water and had got splashed and cooled off by the kids on the wet bounce house slide. While being checked out by the EMTs my pulse kept bouncing back and forth between about 100 and 150 and they got a blood pressure reading of 175/125. They gave me 4 baby aspirin and put me on 2L of oxygen because it dropped slightly. Shortly after getting to the hospital, everything lowered dramatically. BP 100/65 and average pulse of about 70.

My crcl level came back somewhat low for my age, only 66 ml/min. Mayo Clinic lists a normal range for 30-39 year old females as 72-154. Looking back at tests since mid April, it has dropped from 84 to 66. I realize these numbers are not below the standard GFR measure of >60, but feel that they warrant further investigation.

So why is mine so low and is it related to the conditions of my heart? Should I be concerned and ask for further investigation? I have seen a number of conditions that can affect both the heart and kidneys that need treatment; sarcoidosis, amyloidosis, rheumatic diseases. I have a follow up with my EP this Thursday, are these things I should be asking him? I called for a follow up with my family doctor and can't be seen for over a month.



Don't sweat these estimates, because estimates is all they are

by crustyg - 2021-09-01 05:41:23

Unless you've been doing a 24hr urine collection, the numbers that you report are all estimates of your creatinine clearance.  Here in the UK there's a fad for eGFR (attempts to correct for body mass and therefore muscle mass by adding in an estimate of body mass): all it does is provide a veneer of verisimilitude, but it significantly underestimates true GFR and there have been papers published that report the effect this has on population estimates of chronic renal failure - way too high.

It's all tosh.

If a kidney specialist really wants to know your GFR they would organise an inulin-clearance (I know, showing my age again), or at least a 24hr urine collection to measure urinary creatinine.

You are correct that heart issues *can* affect renal blood flow, but you're well into the less common causes and you would be very aware of it - by the time heart output is so low that kidney blood supply is endangered you will look and feel as though you're at death's door.

Much more common is disruption of renal blood flow distribution due to frequent usage of prostaglandin inhibitors (e.g. ibuprofen, aspirin) or overenthusiastic dosing of ACE-inhibitors.  It's possible to have good renal blood supply and suffer tubular damage in this way - and while, in theory, tubular damage alone shouldn't affect GFR, in practice the resulting damage (lack of concentrating ability, loss of solute) shows up in the numbers.

If the conditions that you list all affect you then you should definitely be under the long-term care of someone who sees the big picture: over-specialisation is one of the curses of modern medicine.

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