Do Not 'Kid' Your Kidneys

Kidney Function Blood Test

Routine kidney function is one of the most commonly performed blood tests.

The kidneys

The kidneys regulate the amount of water and salts that we have in our bodies. They do this by filtering the blood through millions of structures called nephrons. The kidneys also pass out certain waste products from the body. Urine is made up of the excess water, salts and waste products passed out by the kidneys down to the bladder.



Routine blood test of kidney function.
The usual blood test which checks that the kidneys are working properly measures the level of urea, creatinine and certain dissolved salts.

Urea is a waste product formed from the breakdown of proteins. Urea is usually passed out in the urine. A high blood level of urea ('uraemia') indicates that the kidneys may not be working properly, or that you have a low body water content (are dehydrated).

Creatinine is a waste product made by the muscles. Creatinine passes into the bloodstream, and is usually passed out in urine. A high blood level of creatinine indicates that the kidneys may not be working properly. Creatinine is usually a more accurate marker of kidney function than urea. The effect of muscle mass needs to be taken into account. A person with a lot of muscle and little fat on their body is likely to have a higher creatinine than a person who has a lot of fat and little muscle.

Estimated glomerular filtration rate (eGFR) provides a guide to kidney function. Although the level of creatinine in the blood is a useful guide to kidney function, the eGFR is a more accurate measure. Blood creatinine can be used to estimate the eGFR using age, sex and race. This is often calculated by computer and reported with the creatinine blood test. The normal value for eGFR is 90-120 ml/min. An eGFR below 60 ml/min suggests that some kidney damage has occurred. The value becomes lower with increasing severity of kidney damage.

Dissolved salts that are routinely measured are sodium, potassium, chloride and bicarbonate. They are sometimes referred to as 'electrolytes'. Abnormal blood levels of any of these may be due to a kidney problem. (Some other conditions may also alter the salt balance in the blood.)

[[Estimated Glomerular Filtration Rate
Various different diseases, conditions and medicines can affect the function of the kidneys. The estimated glomerular filtration rate (eGFR) does not diagnose any kidney disease but is a test to
assess how well your kidneys are working. A reading of greater than 90 ml/min/1.73m2 is normal.

What is the estimated glomerular filtration rate (eGFR)?

The eGFR is a test that is used to assess how well your kidneys are working. The test estimates the volume of
blood that is filtered by your kidneys over a given period of time. The test is called the estimated glomerular
filtration rate because the glomeruli are the tiny filters in the kidneys. If these filters do not do their job properly
then the kidney is said to have reduced or impaired kidney function.

The eGFR test involves a blood test which measures a chemical called creatinine. Creatinine is a breakdown
product of muscle. Creatinine is normally cleared from the blood by the kidneys. If your kidneys are not working
properly, the level of creatinine in the blood goes up.

The eGFR is then calculated from your age, sex and blood creatinine level. An adjustment to the calculation is
needed for people with African-Caribbean origin.

Stages of kidney function

The level of kidney function is divided into five stages:
Stage of Chronic Kidney Disease (eGFR;ml/min/1.73m)

Stage 1: the eGFR shows normal kidney function but you are already known to have some kidney damage or disease. For example, you may have some protein or blood in your urine, an abnormality of your kidney, kidney inflammation, etc.
(90 or more)

Stage 2: mildly reduced kidney function AND you are already known to have some kidney damage or disease. People with an eGFR of 60-89 without any known kidney damage or disease are not considered to have chronic kidney disease (CKD).(60 to 89)

Stage 3: moderately reduced kidney function. (With or without a known kidney disease. For example, an elderly person with ageing kidneys may have reduced kidney function without a specific known kidney disease.) (45 to 59)-(3A); (30 to 44)-(3B)

Stage 4: severely reduced kidney function. (With or without known kidney disease.)  (15 to 29)

Stage 5: very severely reduced kidney function. This is sometimes called end-stage kidney failure or established renal failure.
(Less than 15)

Note: it is not possible to assess the estimated glomerular filtration rate (eGFR) accurately in people with abnormal amounts of muscle and in people who have conditions that can affect the level of creatinine. This includes:

>People with muscle wasting conditions.

>People who have had an amputation of an arm or leg.

>Malnourished people.

>Pregnancy.

>People with acute kidney failure.

>People with a lot of fluid retention (edema).

>Children.]]

Who has a blood test of kidney function?

 Routine kidney function is one of the most commonly performed blood tests. It may be done:

>As part of a general health assessment.

>If you have suspected low body water content (dehydration), when the urea level increases.

>If you have suspected kidney failure.(Read below, Acute Kidney Injury)  The higher the blood levels of urea and creatinine, the less well the kidneys are working. The level of creatinine is usually used as a marker as to the severity of kidney failure. Creatinine in itself is not harmful but a high level indicates that the kidneys are not working properly. So, many other waste products will not be cleared out of the bloodstream. You normally need treatment with dialysis if the level of creatinine goes higher than a certain value.


>Before and after starting treatment with certain medicines. Some medicines occasionally cause kidney damage as a side-effect. Therefore, kidney function is often checked before and after starting treatment with certain medicines.

Other tests of kidney function


The routine kidney blood test is a general marker of kidney function. If the blood test is abnormal it cannot say what is causing the kidney problem. Therefore, if you have an abnormal result you may need further tests to find the cause of a kidney problem. For example: urine tests, other blood tests, scans, X-rays, kidney biopsy, etc.

Acute Kidney Injury

Acute kidney injury is a condition where your kidneys suddenly stop working properly. Usually this happens when you are unwell from another illness. If you have acute kidney injury you are often already ill in hospital. If not, you will usually be sent to hospital to be looked after. The earlier acute kidney injury is picked up, and the more carefully you are monitored, the better the chance of your kidneys recovering.

Acute kidney injury used to be called acute renal failure.


Understanding kidneys: where they are and what they do

The two kidneys lie to the sides of the upper part of the tummy (abdomen), behind the intestines, and either side of the spine. Each kidney is about the size of a large orange but bean-shaped.



A large artery - the renal artery - takes blood to each kidney. The artery divides into many tiny blood vessels (capillaries) throughout the kidney. In the outer part of the kidneys tiny blood vessels cluster together to form structures called glomeruli.

Each glomerulus is like a filter. The structure of the glomerulus allows waste products and some water and salt to pass from the blood into a tiny channel called a tubule. The liquid that remains at the end of each tubule is called urine. The urine then passes down a tube called a ureter which goes from each kidney to the bladder. Urine is stored in the bladder until it is passed out when we go to the toilet.

The main functions of the kidneys are to:

>Filter out waste products from the bloodstream, to be passed out in the urine.

>Help control blood pressure - partly by the amount of water passed out of the body as urine and partly by making hormones which are involved in blood pressure control.

>Make a hormone called erythropoietin, which stimulates the bone marrow to make red blood cells. This is needed to prevent anaemia.

>Control the amount of fluid in the body.

>Help keep various salts and chemicals in the blood at the right level.

What is acute kidney injury (AKI)?

If you have AKI your kidneys suddenly stop working as well as they should. This means the fluid, salts and chemicals in your body can rise or fall to abnormal levels and make you very ill. If there is too much acid, or there are too many salts, in your body your other organs can be affected. For example, your heart, lungs, brain, muscles, eyes, etc, can stop working properly. If the kidneys aren't getting rid of enough fluid, your body can become overloaded with it. This can cause swelling in your legs, or make it difficult to breathe.

It is different from chronic kidney disease (CKD) which is a much more gradual process which can happen over many years.

How common is acute kidney injury (AKI)?

In people who are unwell in hospital, AKI is common. Nearly as many as 1 in 5 people in hospital develop AKI. It is even more common in patients who are extremely unwell in intensive care units.

Who develops acute kidney injury (AKI)?

AKI is more common over the age of 65. People who have another serious illness and are in hospital are more likely to develop it. It may happen to people who are having operations, especially if they are older. It may happen to some people who are having a special X-ray with a dye (contrast) which contains iodine.

Some things make you more likely to develop AKI in these situations - for example:

>Being older.

>Having another illness like diabetes, heart failure or liver disease.

>Being dependent on a carer for fluids.

>Having a bad infection (for example, from a urinary infection, chest infection or skin infection).

>Some medicines - for example:
   -Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or naproxen.
    -Some blood pressure pills that work on the kidney.
    -Some antibiotics called aminoglycosides (such as gentamicin).
    -'Water tablets' (diuretics).

>Lacking in fluid in the body (being dehydrated).

>Another problem with your kidneys, such as CKD.

>Having had AKI before.

Children can develop AKI too. This is more likely if they have:

>Severe diarrhoea.

>A cancer of the blood cells.

>To rely on a parent or carer for fluids (more likely to become dehydrated).

>Low blood pressure.

>Another kidney illness such as nephritis.


>A severe infection.

What causes acute kidney injury (AKI)?


There are many things that can cause the kidneys to stop working properly. Sometimes it happens due to more than one cause.

Causes include:

>Severe infections.

>Blockage in the urinary system.

>Lack of fluid in the body (dehydration).

>Heavy bleeding (haemorrhage).

>Low blood pressure.

>Some medicines (see previous section for medicines that can harm the kidneys).

>Kidney diseases.


>The dye (contrast) that is used for some kinds of scans and X-rays.

What are the symptoms of acute kidney injury (AKI)?

There may be no specific symptoms of AKI. Often you already have symptoms of the illness that has caused AKI.

Symptoms that may happen include:

>Passing less urine than usual.

>Feeling sick or being sick (vomiting).

>Poor appetite.

>Breathlessness.

>Swelling in the legs or other parts of the body.

How is acute kidney injury (AKI) diagnosed?

Your doctor would test for AKI with urine tests and blood tests. Your urine will be measured to see how much you are passing. In most people with AKI, this is less than normal. It will also be tested with a 'dipstick' to check for protein, blood cells and sugar, amongst other things. This will help work out the cause. You will have a blood test for a substance called creatinine. This is an indicator for how well the kidneys are working. Higher levels mean that the kidneys aren't getting rid of waste products as effectively as they should.

You may need an ultrasound scan to look for blockages in the urinary system. Ultrasound scans use sound waves to create a picture of the kidneys and urinary system.

You may also need other tests to try to find the cause for AKI. These might include other blood tests, scans or X-rays.

How is acute kidney injury (AKI) treated?

There isn't a specific medicine to treat AKI. The treatment will depend on the cause of AKI and the severity of the AKI.

The treatment is to carefully look after all the things the kidneys usually do. You will normally be in hospital and have blood and urine tests regularly. You may need extra or special fluid through a drip. You may be on a restricted diet to help get the balance of proteins and salts right. Any medicines which might be harming your kidneys would be stopped. The cause of the problem would be treated if this is possible. (For example, you might need antibiotics for an infection or surgery for any blockage if these were the cause.)

Your doctor will keep a close eye on the balance of minerals and salts in your body. You will have regular tests for potassium, sodium, calcium, sugar (glucose), phosphate and creatinine. You may need treatment with medicines or through a drip if the levels are not right.

Sometimes you need to have dialysis if medicines and fluids aren't working and you are becoming more ill. Dialysis is a procedure where your blood is passed through a machine to remove the waste products (as your kidneys would do if they were working). There are different ways this is done. How often it is done and how long each session lasts will depend on the way it is done. You would be referred to a kidney specialist or an intensive care specialist for this. In most people this can be stopped once the kidneys are working properly again.


These decisions would be made after discussion with you and explaining the options to you (and/or your relatives or carers where appropriate).

What is the outlook (prognosis)?

The outlook varies hugely. It depends on how bad kidney function becomes, who is looking after you, the cause of the problem and how ill you were to begin with.

The National Institute for Health and Care Excellence (NICE) has produced guidelines to try to cut the numbers of people who develop acute kidney injury (AKI) and who die because of it. The outlook is better if it is picked up earlier.

Many people who recover from AKI have normal kidney function afterwards. However, some go on to develop chronic kidney disease (CKD). Some need to keep having dialysis. If you have had AKI once, you are more likely to have it again in the future.

How can acute kidney injury (AKI) be prevented?

Prevention is certainly better than cure for AKI. Patients in hospital should be tested for AKI regularly. This is done by frequent blood tests and measuring how much urine they produce (and weight for children). People having scans or X-rays with a dye (contrast) should be checked to see how likely they are to develop AKI. If they are at risk, and if the test is really necessary, the chances of AKI are lower if these patients have a drip with extra fluid first. They should be regularly checked after the test.


Medicines which cause kidney damage should be avoided where it is possible. If they can't be avoided, the lowest possible dose should be used and tests done regularly to keep a check on how the kidneys are coping.

Letter from Dr Jose A.Rivera

Cured using water: Allergies to cat; Asthma:(from Dr Jose A Rivera,M.D.)

Note: The next two letters are from Jose A. Rivera, M.D. He was the associate professor of medicine at the Capital University of Integrative Medicine in Washington, D.C., USA. He now practices complementary medicine in South Carolina.

Allergies to Cat; Asthma:
Since my letter of 1-6-95, I have been asthma free for approximately 4 years since initially being introduced to your prescription for health in taking water and salt as preventive measure that also cured my asthma attacks. Remembering to watch for signs of stress and fatigue, which can induce bronchial constriction for water preservation and rationing. This is very important since it is during these times that one is unaware of what is really happening physiologically.

Listening to one's own body can enable one to prevent what was once a common occurrence, bronchial constriction that later leads to asthma. It is through these simple directions of hydrating the body with water and regulating the salt levels that one can begin to prevent and cure asthma and heal a body in need of better hydration.

Your prescription for health is certainly a constant reminder to recovering asthmatics.

Thank you for your attention and constant help.
Sincerely,
Jose A. Rivera, M.D.

Enclosed is a summary of some patients who have been treated with water as part of their therapeutic treatment.

Patient # 1 Asthma:

!2-year-old male with history of asthma (non-exertional). patient has been seen by pediatrician and was put on Proventil inhaler. Patient's mother was given misinformation by pediatrician who stated that when a crisis arose to take as many puffs of Proventil until asthma subsides. because of this misinformation, when patient had next crisis the mother gave the patient 6 puffs of Proventil with no amelioration but exacerbation of the symptoms of wheezing, chest tightness, light-headedness and restlessness. The patient was able to lie down but continued to wheeze extensively. The mother gave us a call around 10:30 P.M. with the complaint of wheezing and chest tightness of her son. Immediately we told her to give her son two 8 oz. glasses of water and a pinch of salt on his tongue. We then told her to call us back in 5 minutes for further instructions. To our surprise her son stopped wheezing and his chest tightness had decreased, he was then able to lie down and sleep/ The patient has been instructed to continue to drink water and use salt if another asthma attack occurred. The mother has been made aware that if other medications are needed, to use them as instructed.

Patient # 2 Hypertension; Edema:

67-year-old white female with H/O myocardial infarction, stroke, diabetic retinopathy, hypertension. This patient was seen initially because of her diabetic retinopathy. The patient's above past medical history was under control but we felt that she needed to change some of her fluid intake modality doe to occasional hypertension and unilateral pedal edema. The patient was encouraged to drink two 8 oz. glasses of water before each meal and to cut coffee and other sugar-free drinks from her diet. Within a few days, the patient observed that she was urinating much better and that her pressure had begun to stabilize. She also stated that she had begun to feel much better and that her leg swelling had diminished noticeably. The patient continues to supplement water as part of her normal daily diet.

Our initial observation has been with compliance from all our patients. It is a common practice to tell all patients to eliminate coffee, soft drinks and other beverages and substitute with water. This shift in thinking has been the major obstacle, but we are encouraged when a patient who has felt the need to comply comes with good news of amelioration of symptoms.

We hope that we can continue to give you more reports on our progress as they arrive.

Thank you for your attention.
Sincerely,
Jose A. Rivera, M.D.

The reason people get Edema.

We have been mislead to believe that edema is due to overdrinking of water. The opposite is true, prolonged dehydration had cause edema.

Here you can learn and understand the need for water, salt and potassium together regulate the water content of the human body. Water regulates the water content of the interior of the cell by working its way into all the (trillions)cells it reaches. Water has to get there to cleanse and extract the toxic waste of cell metabolism.

Once water gets into the cells, the potassium content of the cells holds on to it and keeps it there -- to the extent that potassium is available inside the cells.

Even in the plant kingdom, it is potassium in the fruit that gives it firmness by holding water in the interior of the fruit. Our daily food contains ample potassium from its natural sources of fruits and vegetables, but not salt from its natural sources. That is why we need to add salt to our daily diet.
Note: Do not take too much potassium as a dietary supplement (if you are taking right now). It could cause trouble.

Good health depends on a most delicate balance between the volumes of 'watery-oceans' held inside the cells of the human body, and the other 'watery-oceans' held outside the cells. This delicate balance is achieved by the regular intake of water, potassium-rich fruits and vegetables that also contain the organic vitamins needed by the human body, and salt. Unrefined sea salt, which contains some of the other trace minerals that the body needs, is preferable. Avoid the regular table-salt. Sea salt may not contain enough iodine to keep the thyroid gland working normally, and it may enlarge into a goiter. Regular intake of a multivitamin (ensure it's plant based organic supplements) that contains iodine is essential. Another source of iodine is dried kelp capsules, which are available from health food stores/supermarkets.

When water is not available to get into the cells freely, it is filtered from the outside 'salty-ocean' and injected into the cells that are being overworked despite their water shortage. This secondary and emergency means of supplying important cells with injected water is the reason, in severe dehydration, that we retain salt and develop edema -- to have more water available to draw from for filtration and injection into the cells.

Recall, the design of our bodies is such that the extent of the 'ocean-of-water' outside the cells is expanded to have extra water in reserve for filtration and emergency injection into vital cells. To achieve this, the brain commands an increase in salt and water retention by the kidneys. This directive of the brain is the reason we get edema when we don't drink enough water, in accordance to our own body weight, daily. Remember the water-cure formula to calculate your own water quota requirement.

When water shortage in the body reaches a more critical level, and delivery of water by its injection into the trillions cells becomes the main route of supply to more and more cells, an associated rise in injection pressure becomes necessary. The significant rise in pressure needed to inject water into the cells to service them becomes measurable and is labeled "hypertension," or high blood pressure. The drugs used will make the body natural survival functions to deteriorate and cause more complication of organs malfunctions overtime.

Initially, the process of water filtration and its delivery into the cells is more efficient at night when the human body is horizontal, normal sleeping posture. In this position, the collected water, which settles mostly in the legs during the day, does not have to fight the force of gravity to get into the blood circulation. If reliance on this process of emergency hydration of some cells continues for long, the lungs begin to get waterlogged at night, and breathing becomes difficult. The person needs more pillows support to sit upright to sleep. This condition is called cardiac asthma, and it is the consequence of dehydration.

However, in this condition you must not overload the system by drinking too much water at the beginning. All things in nature have natural law governing them. Just be patient and reverse the symptoms slow and steady. Increases in water intake must be slow and spaced out -- until urine production begins to increase at the same rate that you drink water.

When we drink enough water to pass clear urine, we also pass out a lot of the salt that was held back. This is how we can get rid of edema fluid from the body. Not diuretics/more drugs please, but by more gentle increase of water intake! Water is the best natural diuretic and natural detoxicator that exists. You can rest assured of positive results, anytime, with water-cure protocol.

In a person who has extensive edema and whose heart sometimes beats irregularly or rapidly with little effort, the increase in water intake should be gradual and spaced out, but water should not be withheld from the human body. Salt intake should be sea salt, and be limited for two or three days because the body is still in an overdrive mode to retain it. Once the edema has cleared , sea salt should again be added to your diet. If there are irregular heartbeats, or the pulse is fast and furious but there is no edema, increase water, salt, and other minerals such as magnesium, calcium, and some potassium ,all in organic form, will alleviate the problem.