Yea! Creatinine and my nephrologist

[PastorJeff]

For almost two years my creatinine has been at 1.6.  CKD3.  Today i saw my nephrologist and it had gone down to 1.48.  He described me as stable.  Not much of a decrease but we are happy to see any kind since we lose kidney function with age.    

My nephrologist is one of the best doctors I've had.  He gave me all the time I needed and more.  He had other people to see but he throughly reviewed my situation and asked my wife and me again and again if we had any questions.  He said that the thinking is that a lower protein diet of .8 grams per kilo of body weight can be helpful for someone like myself. 

He also expressed his displeasure with the lack of follow up by my transplant center.  Once before he called them entirely on his own to tell them that.  He said the data from living donors is very important so the centers can correctly represent what the experience of living donors is. 

[elephant]

Dear PastorJeff,

Well that is good news.  I've read that kidney function can continue to improve about 3years after donor nephrectomy. 

The classification of kidney donors as having kidney failure is incorrect and can make us "worried well".

Love, elephant 

[Clark]

elephant, we can still experience end stage renal disease. The failure of the transplant industry to adequately adjust the detection thresholds based on our sole kidney function is what we're still working to change.

[elephant]

Dear Clark,

Help me understand how I suggested that kidney donors can not suffer kidney failure?

I do think that the classification of kidney failure in a person who has a single kidney and a stable creatinine level greater than the average normal for a person with two kidneys is incorrect.  It has unfortunate consequences with insurance, unnecessary medical tests, and worry. 

Love, elephant.

[Clark]

You originally wrote:
...The classification of kidney donors as having kidney failure is incorrect and can make us "worried well"...

And replied with:
...the classification of kidney failure in a person who has a single kidney and a stable creatinine level greater than the average normal for a person with two kidneys is incorrect...

My understanding is that there is currently debate as to proper classification of donors who subsequently have function that crosses the existing thresholds into End Stage Renal Disease, either creatinine clearance, GFR, or proteinuria. Some nephrologists or insurance providers behave as if we were not donors even though there's some evidence that reduced function for us should not be considered in the same way. Some applaud this, saying function is function, if we're losing function below established levels for End Stage Renal Disease, we should get appropriate treatment for that condition, whether or not our donation affects our function. The scenario you provide in your follow up post, clarifying your first, is unfamiliar to me. Are you saying that some practitioners or insurance providers are employing stricter thresholds for donors? Or are you decrying the use of the existing thresholds for us? Either way, this implies greater concern for our well being. Is this undesirable?