Autonomic System Effects On Kidney Function?

[louloutinks]

Hi all,

over the past five years I feel I have fallen apart. I have ehlers danlos and was dx'd in feb with pots, autonomic dysfuntion. Last year it was fibromyalgia dx. This year it was kidney function CKD. I get loads of different rashes too.

My first kidney function was stage 3 gfr49. My second test was 59 stage 2. And today my result was gfr 70 stage 2 but very mild. The docs have no reason for my kidney function being low.

I was wondering if autonomic system has an effect on the way the kidneys function? When my kidney reading was at its lowest, I had terrible livedo reticularis, petechiae, felt extremely cold,my pots symtpoms were really bad...bp, dizzy, tachy, tired, RLS.

My doc said it must be coincidence but am wondering if anyone on here jnows different as my local GP's didn't even know ANS could cause headaches!

As the kidney function has improved, so have my pots symptoms...any links???

[firewatcher]

I have stage 3 CKD (egfr of 50) according to my serum Creatinine levels. They have been elevated for the last six years. Total body fluid/plasma levels will effect this test in particular. If you are low in fluid, either hypovolemia or dehydration, your serum creatinine will come back high and your eGFR will come back low. I have seen two nephrologists and neither will look for a cause, they have told me that the best that I can hope for is to maintain the function that I currently have. My doc at Vanderbilt has said that there is no correlation between POTS and kidney damage, but there are studies that implicate the kidney in the dysfunctional mechanisms of POTS. My current cardiologist calls it "end organ damage," due to a lifetime of blood pressure fluctuations.

Unfortunately, this is part of that uncharted territory we all get to eventually. I see my nephrologist next month and have some questions to ask her. I think that there is a connection.

[louloutinks]

That would be interesting to see what they say Firewatcher.

I have charted my BP too and at the lowest GFR (eGFR)I see that my BP was very high. I am usually on the low side but I also do go very high on and off but because of my kidneys I have kept check on it the past few months.

Surely if the ANS is not functioning correctly, and not dealing with the fluids and salts then it may have an effect on the kidneys over time.

Unless as the docs say - coincidence.

How can my GFR go from 49 - 70? I just do not understand it.

[DoozlyGirl]

Hi tinks,

Wow, this is certainly perplexing. I am not sure if it is coincidence but you may want to consider a non-medical possibility for your values going from 49 to 70. I may be going out on a limb here, and I am not sure how this may have specifically impacted your results, but depending on when your previous eGFRs were calcuated, this may have contributed to your differing values.

In 2005 the NIKKD (part of NIH) approved a plan to standardize serum creatinine (SrCr) values across the country by initiating that each lab use the same "gold standard" method -IDMS methodology- to calulate SrCr. SrCr is one way to estimate GFR, which is differentiated from observed GFR, thus called eGFR.

In 2009/10, there was a stronger push to roll out this standardized protocol. I learned of it when my previous employer's corporate laboratory converted to IDMS, but never bothered to inform other departments. I worked in diagnositic imaging administration at that time and this really threw a wrench in our assessments to determine if patient's renal function could tolerate MRI or CT contrast. For decades, MRI had used MDRD methodology and CT used Crockroft-Gault methodology to caculate eGFR (same was true across the country), and in the end my hospital system ended up converting to IDMS corrected (think fudge factor) serum creatinine as well as MDRD methodology to assess patients for possible contrast use. I worked with someone at the NKDEP to better understand all this, and at that time, they were unaware of potential issues outside of the lab or pharmacy. Same may be true here. Since different methodologies have varying limitations, some don't consider muscle mass/weight, which can vary values, depending upon which equation was used to calulate the eGFR.

We did notice that patient's previous calculations varied from values calculated after the conversion (to this new MDRD calculation methodology using this new IDMS standardized SrCr values). At that time I read that IDMS SrCR values are 6% lower and that using a MDRD calculation accounting for this IDMS SrCR can yield a 10-20% shift in the eGFR calculation.

I am sending a link from the NKDEP joint effort explaining this protocol shift. NKDEP link. There are details on the lab professionals pages.

Hopefully, your nephrologist will be aware of this change and help determine if it explains your shifting eGFR values. Your nephrologist may also want to assess your kidneys in another way, perhaps measuring GFR directly. I realize that I didn't address your question regarding ANS impacting kidney function, but in my research EVERYTHING can be impacted directly or indirectly by a dysfunctional ANS. Wonder if anyone with a laboratory or pharmacy background can contribute to this possibility?

Best Wishes, Lyn

[louloutinks]

Hey Lyn, thanks for the detailed reply and the link. I did ensure that I went to the same place to have my bloods taken each time. I will check out the link when I have done this post!

I would have thought that it could have an effect - I was told that it could have an effect on everything in the body that is 'automatic'. So if the ANS in awry or having a hard time at sending the correct signals, I do not see how this is not a possibility.

Lou

The link did not work...took me to an ad page!!!

[firewatcher]

Just out of curiosity, are you basing all this on eGFR? What has your serum Creatinine been? Do you have protein in your urine and have you had a Creatinine Clearance test done?

My SCr has been as high as 1.34, and my CrCl test confirmed reduced kidney filtration rate. I've never had protein in my urine, but with a SCr that high, I didn't need it for the dx.

I was told that kidney function could not improve once it was lost, but mine has yo-yo-ed quite a bit. I also belong to a kidney forum and there are people on there whom also show variability, what counts is the trend over time. I am currently steady or improving (we'll see with the next labs,) so I am considered stable at stage 3.

[kluesyk]

I too have fluctuating GFR numbers form 70 too 50 when ill. My creatinine also goes up when GFR goes down. as well as my urine PH goes high(8),

I am seeing a nephrologist that is trying to figure out why I can't keep my potassium and magnesium. Even though I take supplements, they are low.

Urine spot test was low in potassium, too, so I don't know where it is going.....

The fact that my renin is low, when I have POTS(poss low blood volume), & aldosterone is low does seem to indicate the kidney as part of the problem.

I also have bad left side kidney pain when upright very long....which usually triggers increased urination.

I suggested the nephrologist rule out a left renal vein compression, but am still waiting on a call back....having a hard time finding someone in my small town that knows how to scan(ultrasound) for this. I need to be standing up, sitting and lying down to accurately show if I have compression.

[DoozlyGirl]

Lou, lets try this again. I have included both the link as well as the URL in case you have to cut and paste it into your browser.

Lyn

http://www.nkdep.nih.gov/labprofessionals/Clinical_Laboratorie

SrCr standardization NKDEPs.htm

[DoozlyGirl]

Lou,

PS I googled "IDMS creatinine" and selected the second post on my browser, which was from the NKDEP.

Lyn

[louloutinks]

Just out of curiosity, are you basing all this on eGFR? What has your serum Creatinine been? Do you have protein in your urine and have you had a Creatinine Clearance

yes it was based on the serum creatinine....I thought that was how it was always done!- first one was 114 and think the second was 98/99 an dI do not know the third - they just told me the eGFR.

I didnt think that it could improve like this - so that is why I am wondering autonomic stuff - what else could cause this decrease and increase? I have no explanations of anything - and now doc wants yearly checks only which is good but I would like to know the cause of it in the first place!

I managed to open the link, so thank you for reposting that - reading that was heavy going for my pea brain!

[firewatcher]

Tinks,

A Creatinine Clearance test is an old test that measures 24 hour urine creatinine against serum creatinine. It weeds out any artifactual reporting of kidney damage. If both numbers indicate that your kidneys are not clearing creatinine, then the dx is confirmed. I have an actual reduction of GFR confirmed by both tests. HOWEVER, there are many things that will appear to raise serum creatinine, from dehydration to exercise to vitamin C.

I was told that my kidney function could not improve, but honestly, in the last six months it has...according to the serum creatinine tests. I have another test at the end of this month, so we'll see if it holds.

If you truly DO have kidney damage, don't let them tell you that there is nothing they can do. I've severely limited my protein intake, along with other things and my GFR has improved.

[louloutinks]

Hi FW,

These tests were ordered as part of some checks they were doing few months back at my local docs. They have requested that I go back every 6 weeks for the blood test but now it is 70 they say to test in a years time. I did not do a 24 urine test and I havent seen a nephrologist (?) as all this was done by my local GP. They told me it corresponded to CKD stage 3 and 2,but they asked for a urine sample which I dropped in today - checking ACR/PCR whatever that is.They said that eGFR of 70 is nothing to be concerned about and that he was happy with the result.

I was in hospital with nephritis...or pyelonephritis(I had one and my mum had the other so we get confused who had what!) 22 years ago so the doc is going to check my records for that one.

I am certainly not dehydrated - I used to drink lots of water but have drunk lots more since pots dx.

I hope that your results come back with more improvement. Are you in the UK or the US? If you are in US, do they use the same methods over here in UK? Wonder why they didn't bother testing my urine previously when I had the highest creatinine.

I did ask them if this could be the reason for my hands swelling badly when I take extra salt for Pots and I asked them if I should stop salt but they said no (but I did).

Thanks for all your help in this - you have opened my eyes a bit!