Re: Current eGFR Caculation Standards

[Guest guest]

GFR calculation is based on interpolation of the known results. So basically

they don't test your GFR but rather they say because many other people of

your age and height and CREA have shown this much GFR so they assign that

much GFR to you too. My GFR is calculated based on a serum random CREA

instead of urine uCREA because there is a correlation between urine uCREA

and serum CREA which is implemented into MDRD interpolation formulae and as

all interpolation formulas, extrapolation away from the average range is

usually not reliable unless a true GFR test is performed which is time

consuming and perhaps expensive.

Max.

|

|I spent some time this morning trying to get to the bottom of the eGFR

question

|and think I understand it well enough to intelligently discuss it with my

|Neurologist in November. I have not tried to editorialize or replicate it

here but

|simply pointed the reader where they can find the information, if so

inclined,

|and draw their own conclusions! (It appears to be accurate as of March,

2011

|and is accurate and been implemented in the U.S. Sorry for our non-U.S.

|readers, I guess you are on your own!)

|

|

|Source: http://www.nkdep.nih.gov/labprofessionals/Clinical_Laboratories.htm

|

|Creatinine Standardization Recommendations

[Guest guest]

As I recall the estimation is different in blacks and does not work well over age 70. Can you start a file on GFR INFO with this info in it. ThanksTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I spent some time this morning trying to get to the bottom of the eGFR question and think I understand it well enough to intelligently discuss it with my Neurologist in November. I have not tried to editorialize or replicate it here but simply pointed the reader where they can find the information, if so inclined, and draw their own conclusions! (It appears to be accurate as of March, 2011 and is accurate and been implemented in the U.S. Sorry for our non-U.S. readers, I guess you are on your own!)

Source: http://www.nkdep.nih.gov/labprofessionals/Clinical_Laboratories.htm

Creatinine Standardization Recommendations

Use a creatinine method that has calibration traceable to an IDMS reference measurement procedure. Methods based on either enzymatic or Jaffe method principles should have calibration traceable to IDMS.

In the US, all major manufacturers now (2011) provide clinical laboratory methods with calibrations that are claimed to be traceable to IDMS. In March, 2011, Siemens Healthcare Diagnostics issued a technical bulletin ….

Source: www.kidney.org/professionals/KDOQI/guidelines_ckd/p5_lab_g4.htm

KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification

PART 5. EVALUATION OF LABORATORY MEASUREMENTS FOR CLINICAL ASSESSMENT OF KIDNEY DISEASE

GUIDELINE 4. ESTIMATION OF GFR

If you decided to read only part of it, make sure you don't miss Table 52. (It's the "Exception List" where different testing may be necessary.)

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

[Guest guest]

Not time consuming except for pt who must be a good urine collector and timer. I have found an excellent like for nephrology for med students and will send. Was FROM KANSAS U Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

GFR calculation is based on interpolation of the known results. So basically

they don't test your GFR but rather they say because many other people of

your age and height and CREA have shown this much GFR so they assign that

much GFR to you too. My GFR is calculated based on a serum random CREA

instead of urine uCREA because there is a correlation between urine uCREA

and serum CREA which is implemented into MDRD interpolation formulae and as

all interpolation formulas, extrapolation away from the average range is

usually not reliable unless a true GFR test is performed which is time

consuming and perhaps expensive.

Max.

|

|I spent some time this morning trying to get to the bottom of the eGFR

question

|and think I understand it well enough to intelligently discuss it with my

|Neurologist in November. I have not tried to editorialize or replicate it

here but

|simply pointed the reader where they can find the information, if so

inclined,

|and draw their own conclusions! (It appears to be accurate as of March,

2011

|and is accurate and been implemented in the U.S. Sorry for our non-U.S.

|readers, I guess you are on your own!)

|

|

|Source: http://www.nkdep.nih.gov/labprofessionals/Clinical_Laboratories.htm

|

|Creatinine Standardization Recommendations

[Guest guest]

Yes, There is a factor if you are female and another if you are African American

and I presume both apply if you are a female African American but I didn't pay

much attention since neither applied. I did pay more attention to age since

apparently it is " normal " for GFR to reduce as age progresses over 70!

I did NOT try to actually do the calculations since I presume the labs that are

more accurate than I! There are also online calculators that will do it for

you!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> > I spent some time this morning trying to get to the bottom of the eGFR

question and think I understand it well enough to intelligently discuss it with

my Neurologist in November. I have not tried to editorialize or replicate it

here but simply pointed the reader where they can find the information, if so

inclined, and draw their own conclusions! (It appears to be accurate as of

March, 2011 and is accurate and been implemented in the U.S. Sorry for our

non-U.S. readers, I guess you are on your own!)

> >

> > Source: http://www.nkdep.nih.gov/labprofessionals/Clinical_Laboratories.htm

> >

> > Creatinine Standardization Recommendations

> >

> > Use a creatinine method that has calibration traceable to an IDMS reference

measurement procedure. Methods based on either enzymatic or Jaffe method

principles should have calibration traceable to IDMS.

> >

> > In the US, all major manufacturers now (2011) provide clinical laboratory

methods with calibrations that are claimed to be traceable to IDMS. In March,

2011, Siemens Healthcare Diagnostics issued a technical bulletin ….

> >

> > Source: www.kidney.org/professionals/KDOQI/guidelines_ckd/p5_lab_g4.htm

> >

> > KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation,

Classification, and Stratification

> > PART 5. EVALUATION OF LABORATORY MEASUREMENTS FOR CLINICAL ASSESSMENT OF

KIDNEY DISEASE

> >

> > GUIDELINE 4. ESTIMATION OF GFR

> >

> > If you decided to read only part of it, make sure you don't miss Table 52.

(It's the " Exception List " where different testing may be necessary.)

> >

> > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt.

flank & testicle pain. I have decided against an adrenalectomy at this time

since Meds. are working so well. Current BP(last week ave): 122/73

> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> >

> >

>

[Guest guest]

IMHO it is not so much the lack of ability of the PTN but the LACK OF TRUST by

the Doctor! Since we don't have in excess of 19 years of schooling they think

we can't " piss in a jar " correctly or the jar will be contaminated with germs

etc. or we will " spill some of the Liquid Gold " or we will have an adversion to

storing it next to the Milk (low fat)and cheeze we are going to feed our

(grand)kids AND THE LIST GOES ON!

I have been accused of providing too much urine even though I learned to tell

time in the second grade, granted, I had to relearn when the digital age came!

I have been accused of cheating on my BP tests by only taking it after I take my

meds, this by a doctor that only took it after arguing with me for 30 minutes

and taking it once with my arm hanging at my side! I now promise anyone that

looks at my results that they were obtained in the morning prior to meds and

don't record the time!

Why would one cheat, there is only one person that it is going to kill! I once

had a " friend " suggest I protest when my child wasn't promoted in a Red Cross

swimming test! (Sure, get that diploma and we'll throw him in the deep end and

all gather to WATCH HIM DROWN!)

End of RANT. I believe they use an ESTIMATED GFR to rule out ninety someodd per

cent and identify the ones that need to be further tested. Not only do they

eliminate the various possibilities of error, the expenses are also reduced.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> > GFR calculation is based on interpolation of the known results. So basically

> > they don't test your GFR but rather they say because many other people of

> > your age and height and CREA have shown this much GFR so they assign that

> > much GFR to you too. My GFR is calculated based on a serum random CREA

> > instead of urine uCREA because there is a correlation between urine uCREA

> > and serum CREA which is implemented into MDRD interpolation formulae and as

> > all interpolation formulas, extrapolation away from the average range is

> > usually not reliable unless a true GFR test is performed which is time

> > consuming and perhaps expensive.

> >

> > Max.

> >

> > |

> > |I spent some time this morning trying to get to the bottom of the eGFR

> > question

> > |and think I understand it well enough to intelligently discuss it with my

> > |Neurologist in November. I have not tried to editorialize or replicate it

> > here but

> > |simply pointed the reader where they can find the information, if so

> > inclined,

> > |and draw their own conclusions! (It appears to be accurate as of March,

> > 2011

> > |and is accurate and been implemented in the U.S. Sorry for our non-U.S.

> > |readers, I guess you are on your own!)

> > |

> > |

> > |Source: http://www.nkdep.nih.gov/labprofessionals/Clinical_Laboratories.htm

> > |

> > |Creatinine Standardization Recommendations

> >

> >

>

[Guest guest]

Maybe they could provide you a " Nurse for a Day " to supervise and help when

necessary! (In your case it would have to be a 6'3 " strapping male nurse to

carry such a heavy load! ;>)

>

> Labs should simplify this process of 24 hr urine collection. A mechanism can

> be added to the large collection bottle that at the end of 24 hr, patient

> shake the bottle well and this fills the small tube with properly mixed

> urine and this tube is separated from the large bottle and taken to the lab

> instead of running up and down the hallways with 3.5 litters of heavy yellow

> urine...it stretches my hands by inches!

>

> Max.

>

> |

> |IMHO it is not so much the lack of ability of the PTN but the LACK OF TRUST

> by

> |the Doctor! Since we don't have in excess of 19 years of schooling they

> think we

> |can't " piss in a jar " correctly or the jar will be contaminated with germs

> etc. or

> |we will " spill some of the Liquid Gold " or we will have an adversion to

> storing it

> |next to the Milk (low fat)and cheeze we are going to feed our (grand)kids

> AND

> |THE LIST GOES ON!

> |

> |I have been accused of providing too much urine even though I learned to

> tell

> |time in the second grade, granted, I had to relearn when the digital age

> came! I

> |have been accused of cheating on my BP tests by only taking it after I take

> my

> |meds, this by a doctor that only took it after arguing with me for 30

> minutes and

> |taking it once with my arm hanging at my side! I now promise anyone that

> looks

> |at my results that they were obtained in the morning prior to meds and

> don't

> |record the time!

> |

> |Why would one cheat, there is only one person that it is going to kill! I

> once had

> |a " friend " suggest I protest when my child wasn't promoted in a Red Cross

> |swimming test! (Sure, get that diploma and we'll throw him in the deep end

> and

> |all gather to WATCH HIM DROWN!)

> |

> |End of RANT. I believe they use an ESTIMATED GFR to rule out ninety

> someodd

> |per cent and identify the ones that need to be further tested. Not only do

> they

> |eliminate the various possibilities of error, the expenses are also

> reduced.

> |

> | - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt.

> |flank & testicle pain. I have decided against an adrenalectomy at this

> time

> |since Meds. are working so well. Current BP(last week ave): 122/73 Other

> |Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

> |Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

> |81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> |

> |

>