eGFR Calculation for 51-Year-Old Male with Creatinine 15.1 mg/dL
This patient has an estimated GFR of approximately 4 mL/min/1.73 m², indicating Stage 5 chronic kidney disease (kidney failure) requiring urgent nephrology referral and likely imminent renal replacement therapy. 1
Calculation Using MDRD Equation
Using the MDRD 4-variable equation, which is the preferred method for patients with reduced kidney function: 2
eGFR = 175 × (15.1)^-1.154 × (51)^-0.203 = approximately 4 mL/min/1.73 m² 2, 1
- The MDRD equation is more accurate than Cockcroft-Gault for GFR <90 mL/min/1.73 m² 2
- This formula requires only age, sex, race, and serum creatinine—no height or weight needed 2
- For a 51-year-old male with creatinine 15.1 mg/dL, the calculation yields an eGFR in the range of 3-5 mL/min/1.73 m² 1
Clinical Classification and Urgency
This patient is in Stage 5 CKD (kidney failure), defined as eGFR <15 mL/min/1.73 m² 2
- Stage 5 CKD typically requires dialysis initiation, as approximately 98% of U.S. patients begin dialysis when GFR falls below 15 mL/min/1.73 m² 2
- At this level of kidney function, uremic symptoms are expected and metabolic derangements (hyperkalemia, metabolic acidosis, fluid overload, anemia) are highly likely 3
- Immediate nephrology referral is mandatory—guidelines strongly recommend referral for eGFR <30 mL/min/1.73 m², and this patient is far below that threshold 2
Critical Management Considerations
This patient requires urgent evaluation for renal replacement therapy (hemodialysis, peritoneal dialysis, or transplantation): 2
- Monitor serum potassium and creatinine levels urgently, as life-threatening hyperkalemia is a major risk at this level of kidney function 2
- All renally-excreted medications must be dose-adjusted or discontinued to prevent toxicity 2
- Assess for uremic complications including pericarditis, encephalopathy, bleeding diathesis, and severe metabolic acidosis 2
- Evaluate volume status and blood pressure control, though ACE inhibitors/ARBs may need adjustment given severe renal impairment 2
Important Caveats
The extremely elevated creatinine of 15.1 mg/dL should prompt verification: 2
- Confirm this is not a laboratory error by repeating the measurement 2
- Rule out acute kidney injury superimposed on chronic kidney disease by reviewing prior creatinine values 2
- Consider whether recent rhabdomyolysis, severe dehydration, or urinary obstruction could be contributing 2
- In patients with extremes of body size, severe malnutrition, or rapidly changing kidney function, direct GFR measurement may be more accurate than estimation 2
At this critical level of kidney function, the patient likely has uremic symptoms and metabolic complications requiring immediate intervention, not just monitoring. 2, 3