From the Guidelines
There is minimal cause for concern regarding the elevated BUN in this 73-year-old female with a GFR of 68, as it likely represents a mild, age-related reduction in kidney function or a pre-renal pattern that can be managed with hydration and dietary adjustments. The BUN of 26 is slightly elevated above the normal range, while the creatinine of 0.9 mg/dL is within normal limits for her age. According to the National Kidney Foundation practice guidelines for chronic kidney disease 1, a GFR level less than 60 mL/min per 1.73 m² represents a loss of half or more of the adult level of normal kidney function, but the patient's GFR is still above this threshold. Some key points to consider in managing this patient's condition include:
- Maintaining good hydration, approximately 6-8 glasses of water daily, to help reduce BUN levels and support kidney function.
- Following a balanced diet moderate in protein, as high protein intake can put additional strain on the kidneys.
- Continuing regular medical follow-up with annual kidney function tests to monitor for any changes in kidney function.
- Reviewing medications that might affect kidney function, such as NSAIDs, certain antibiotics, or blood pressure medications, with her doctor to ensure they are necessary and appropriately dosed. Given the patient's age and mild reduction in kidney function, it is essential to prioritize management strategies that support overall kidney health and minimize the risk of further decline, as decreased GFR in the elderly is an independent predictor of adverse outcomes, such as death and cardiovascular disease 1.
From the Research
Patient's Renal Function
- The patient's GFR is 68, which is considered to be within the normal range, but close to the threshold for chronic kidney disease (CKD) 2.
- The patient's creatinine level is 0.9, which is within the normal range.
- The patient's BUN level is 26, which is slightly elevated.
Concerns and Recommendations
- The elevated BUN level may be a cause for concern, as it can indicate dehydration, heart failure, or renal disease 3.
- The ratio of BUN to creatinine is approximately 29, which is higher than normal, and has been associated with increased mortality in patients with renal disease 4.
- It is recommended to monitor the patient's renal function closely, including regular measurements of GFR, creatinine, and BUN levels.
- The patient's doctor may consider ordering additional tests, such as urine albumin or cystatin C, to further assess renal function 5.
- Lifestyle modifications, such as maintaining a healthy diet and staying hydrated, may help to slow the progression of renal disease 2.