Alternative Names: GFR; Estimated GFR; eGFR
What is GFR?
GFR is a blood test that measures how much blood your kidneys filter each minute, which is known as your glomerular filtration rate (GFR). You have two kidneys. Their main job is to filter wastes and extra water out of your blood to make urine. eGFR is a measure of how well your kidneys are working. Measuring serum creatinine along with an estimated glomerular filtration rate (eGFR) is recommended as the first step in GFR evaluation by current clinical practice guidelines. Your eGFR is an estimated number based on a blood test and your age, sex, body type and race. eGFR is considered a mostly reliable test for doctors to know how well your kidneys are working. However, the eGFR may not be accurate if you are younger than 18, pregnant, very overweight or very muscular. In addition, other tests such as an ultrasound or a kidney biopsy may be ordered to find a cause of your kidney disease.
When is an eGFR test ordered?
Your healthcare provider will order an eGFR test if they suspect you have chronic kidney disease (CKD). The marker may also be included in your yearly general wellness labs that look at general kidney function. So, if you complain about having symptoms of kidney disease or are getting routine labs, your practitioner may order an eGFR test. Early-stage CKD does not usually cause symptoms, but your doctor may recommend an eGFR test if you are at higher risk of developing the disease.
CKD risk factors include:
- Diabetes
- High blood pressure
- Overweight/obesity
- Over the age of 60
- Family history of CKD or kidney failure
Usually, developing CKD is not due to any single reason, but because of a combination of physical, environmental, and social factors.
Measuring and estimating GFR:
Getting an accurate GFR level is challenging because measured GFR (mGFR) is a complicated and lengthy process. This makes it impractical for both clinicians and patients. It is for this reason that healthcare professionals use a formula to estimate GFR. Often, CKD (=chronic kidney disease) does not have any symptoms until the later stages of the disease. This is the reason why reliable estimates of GFR are so important for identifying CKD as early as possible. The standard way to estimate GFR is with a simple blood test that measures your creatinine levels. Creatinine is a waste product that comes from the digestion of dietary protein and the normal breakdown of muscle tissue. Aside from CKD, creatinine levels can be affected by other factors including diet; muscle (weight of your muscles); malnutrition; and other chronic illnesses.
What are symptoms of kidney disease?
Symptoms of kidney disease include:
- Dry and persistently itchy skin
- Muscle cramps
- Swollen ankles and feet
- Increase in frequency of urination
- Foamy or bloody urine
- Sleep problems
- Fatigue and low energy levels
- Concentration problems
- Nausea and vomiting
- Poor appetite
- High blood pressure
Kidney disease:
CKD (chronic kidney disease) means the kidneys are damaged and may no longer filter blood well. This damage happens over many years. As more damage occurs, the kidneys are unable to keep the body healthy - then dialysis or a kidney transplant may be needed to maintain health. Your kidneys filter your blood by removing waste and extra water to make urine. The glomerular filtration rate (GFR) shows how well the kidneys are filtering. An estimated 37 million adults in the United States may have chronic kidney disease (CKD) but nearly 90% are unaware of their condition. When found early, people can take important steps to protect their kidneys.
Early-stage kidney disease does not normally have any symptoms. Because of this, if you have any preexisting conditions like diabetes, high blood pressure, and cardiovascular disease (all of which tend to affect your kidneys) your healthcare provider will likely order this test for you at regular intervals. A family history of kidney disease could also necessitate this test.
Further, if you’ve already been diagnosed with kidney disease, your practitioner will likely still order an eGFR test regularly to monitor how well your kidneys are faring.
The main function of your kidneys is to clean your blood. The glomeruli, tiny filters found in your kidneys, are central to this job. So, your eGFR rate is actually how much blood these glomeruli filter per minute, and it works by measuring the levels of creatinine in your blood.
Why is Creatinine (and Cystatin C) so important here?
Creatinine is one of the types of waste that the kidneys help to filter out of the body. Therefore, if a high level of creatinine is found in your blood, it might signal that your kidneys (the glomeruli, in particular) aren't doing a good job of filtering and cleaning out your blood.
While most commonly used, creatinine is not the only substance that can be used to estimate GFR. For example, some eGFR tests measure cystatin C, a protein made by most types of cells in the body. Unlike creatinine, the blood level of cystatin C is less influenced by differences in our body, such as muscle mass, physical activity, and diet.
Therefore cystatin C-based calculation of eGFR is more accurate in some circumstances. You may ask your doctor if cystatin C-based eGFR is a better test for you.
Why do my test results show an African American and a Non-African American value for my eGFR?
Race was originally included in eGFR calculations because clinical trials demonstrated that people who self-identify as Black/African American can have, on average, higher levels of creatinine in their blood. It was thought the reason why was due to differences in muscle mass, diet, and the way the kidneys eliminate creatinine. Since a patient’s race is not always used when laboratory tests are ordered, laboratories used different eGFR calculations for African American and non-African American and included both numbers in their lab results. The use of race in calculating eGFR has been a subject of debate. Race is not a biological concept, but a social construct. Using race as a factor for calculating eGFR does not account for the diversity within communities of color. Also, people who self-identify as multiracial might not want to be put in a single racial bucket.
eGFR is an estimate of how well your kidneys are working. The way eGFR is calculated will be changing. Currently the test considers your age, sex and race, among other things. A task force led by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) is working on recommendations that may remove Black race as a factor in the eGFR calculation. The task force has been seeking the input of kidney disease experts to come up with the best way to make the eGFR test as accurate as possible. American Kidney Fund (AKF) advised the task force to remove race from the eGFR so there is no bias in testing kidney function. This would help to make sure that every person will receive health care that is fair and of the highest quality.
Can kidney disease get better?
CKD usually will not get better and is likely to get worse. Treatment helps slow kidney disease and keep the kidneys healthier longer. People with CKD often take medicines to low blood pressure, control blood sugar, and lower blood cholesterol. Two types of blood pressure medications—ACE inhibitors and ARBs—can slow CKD and delay kidney failure, even in people who do not have high blood pressure.
What can I do to keep my kidneys healthy?
No matter what your eGFR is, take these steps to keep your kidneys as healthy as possible:
- Keep a healthy blood pressure (less than 120/80 for most people).
- Control your blood sugar if you have diabetes.
- Follow a healthy low-salt, low-saturated-fat eating plan.
- Do something active for at least 30 minutes most days of the week, such as walking or biking.
- Keep a weight your doctor says is healthy for you.
- Do not smoke or use tobacco.
- Ask your doctor about medicines that may help protect your kidneys.
What other tests should I consider?
If you’ve been diagnosed with kidney disease from your eGFR test results, your pracitioner may order the following tests for you:
Kidney biopsy: This test involves taking a small price of your kidney for microscopic examination. This is done in order to determine the exact type of kidney disease you have, and how far the disease has progressed so that an appropriate treatment plan can be devised.
Ultrasound or CT Scan: Either of these imaging tests may be ordered so that your healthcare provider can get a clear picture of your kidneys, and determine what state they’re in.
In addition to this, your practitioner may also refer you to a nephrologist—a healthcare provider that specializes in kidney problems—to determine the next steps and help manage your condition.
It is extremely necessary to have an open and detailed conversation about your eGFR result with your healthcare provider. If you’d like, you can also opt to take the test in another hospital or seek out a second medical opinion on your initial diagnosis.
No matter what your eGFR is, ask your doctor when you should be tested again and what other tests you should have. Your doctor may want to do other tests to look for signs of kidney problems, such as:
- Urine test for protein or blood
- Blood test for other wastes
- Blood pressure
- Blood sugar (glucose) test
What are the ranges for eGFR?
The result is often listed as milliliters per minute per 1.73 square meters of body surface area (mL/min/1/.73m2). In adults, the normal eGFR number is usually more than 90. eGFR declines with age, even in people without kidney disease.
eGFR of 90 or higher is in the normal range
eGFR of 60 - 89 may mean early-stage kidney disease
eGFR of 15 - 59 may mean kidney disease
eGFR below 15 may mean kidney failure
Age (years) and average eGFR:
20–29 -- 116
30–39 -- 107
40–49 -- 99
50–59 -- 93
60–69 -- 85
70+ -- 75
Understanding your results:
There are five stages of kidney disease. Your healthcare professional determines your stage of kidney disease based on the amount of kidney damage shown by your eGFR or mGFR. Now that you know your eGFR, find out your kidney disease stage using the table below.
What are the stages of chronic kidney disease (CKD)?
| Stage | Description | eGFR | Kidney Function |
| 1 | Possible kidney damage (e.g., protein in the urine) with normal kidney function | 90 or above |
90-100% |
| 2 | Kidney damage with mild loss of kidney function | 60-89 |
60-89% |
| 3a | Mild to moderate loss of kidney function | 45-59 |
45-59% |
| 3b | Moderate to severe loss of kidney function | 30-44 |
30-44% |
| 4 | Severe loss of kidney function | 15-29 |
15-29% |
| 5 | Kidney failure | Less than 15 |
Less than 15% |
The underlying measurement and formula used to estimate GFR may be detailed on an eGFR test report. Your doctor can also provide this information about your test. It is only your healthcare provider that can give you the most accurate interpretation of your results based on your eGFR result and other individual symptoms, complications, and medical history.
You should also note that your eGFR test result can be influenced by many factors. This means that you may not get a correct eGFR result if:
- You’re pregnant
- You’re under the age of 18
- You’re elderly, as you’re likely to have a low eGFR if you’re elderly because GFR normally declines with age
- You’re on a vegan or vegetarian diet
- You’re significantly more or less muscular than the average person
Accordingly, your healthcare provider will look at these things, if any apply to you, before making a diagnosis of chronic kidney disease (CKD), or ordering further tests to confirm the diagnosis.
Depending on your eGFR test result and other surrounding medical information, your healthcare provider may not make a definitive diagnosis of kidney disease. Instead, he/she may ask you to come back for another eGFR test to check if the result remains the same.
Sources:
https://www.kidneyfund.org/all-about-kidneys/tests/blood-test-egfr
https://www.kidney.org/atoz/content/gfr
https://www.kidney.org/content/kidney-failure-risk-factor-estimated-glomerular-filtration-rate-egfr
https://www.niddk.nih.gov/health-information/professionals/advanced-search/explain-kidney-test-results
https://www.testing.com/tests/estimated-glomerular-filtration-rate-egfr/
References:
Krishnan A, Levin A. Laboratory assessment of kidney disease: glomerular filtration rate, urinalysis, and proteinuria. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 23.
Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 106.
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High GFR may reflect hyperfiltration, which typically occurs in patients with diabetes mellitus and obesity.
Thus, subgroups of patients at higher cardiovascular risk may have higher GFR than individuals without these cardiovascular risk factors.
Because of its association with cardiovascular risk factors, hyperfiltration may be a marker (but not necessarily a mediator) of future cardiovascular disease.
In the long-term run, hyperfiltration may predispose to glomerular damage and subsequent loss in kidney function, which themselves directly contribute to cardiovascular disease. Prospective clinical data on the association between hyperfiltration, future GFR loss and subsequent cardiovascular disease are scarce.
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What can you do to protect your kidney function?
- Get your kidneys checked at least every year. Your healthcare team will do a simple blood test to find out your eGFR. They will also do a urine albumin-to-creatinine ratio (UACR), which shows if you have protein (albumin) in the urine. Protein in the urine may mean you have kidney damage.
- Control blood pressure if you have high blood pressure.
- Control blood sugar if you have diabetes.
- In general, if you have CKD, avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.
- If you have CKD, tell your healthcare team before having any test that uses contrast dye.
- Do not smoke.
- Exercise and follow a healthy diet that's low in sodium, saturated fat, and sugar, but high in fresh fruits, vegetables, whole grains, lean meats, fish, and poultry. Avoid highly processed foods.
- Stay at a healthy weight. Lose weight if your healthcare team says that you should.
- Discuss any vitamins, minerals, herbs, weight loss or body building supplements with your healthcare team before taking them. Many of these products can hurt your kidneys.
- Make sure that any drugs you take are the right dose for your age and your level of kidney function. You should discuss this with your healthcare team.
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If your eGFR number is low, your kidneys may not be working as well as they should. People with a lower eGFR are at increased risk of having chronic kidney disease (CKD) progress to kidney failure. The sooner that kidney disease is found, the better the chance of slowing or stopping it from getting worse.
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A GFR below 60 for three months indicates chronic kidney disease. While you cannot raise your GFR, you can stop it from getting lower.
What can you do to protect your kidney function?
- Get your kidneys checked at least every year. Your healthcare team will do a simple blood test to find out your eGFR. They will also do a urine albumin-to-creatinine ratio (UACR), which shows if you have protein (albumin) in the urine. Protein in the urine may mean you have kidney damage.
- Control blood pressure if you have high blood pressure.
- Control blood sugar if you have diabetes.
- In general, if you have CKD, avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.
- If you have CKD, tell your healthcare team before having any test that uses contrast dye.
- Do not smoke.
- Exercise and follow a healthy diet that's low in sodium, saturated fat, and sugar, but high in fresh fruits, vegetables, whole grains, lean meats, fish, and poultry. Avoid highly processed foods.
- Stay at a healthy weight. Lose weight if your healthcare team says that you should.
- Discuss any vitamins, minerals, herbs, weight loss or body building supplements with your healthcare team before taking them. Many of these products can hurt your kidneys.
- Make sure that any drugs you take are the right dose for your age and your level of kidney function. You should discuss this with your healthcare team.
What are the Stages of Chronic Kidney Disease (CKD) that match eGFR levels?
Stage 1: Kidney damage with normal kidney function (GFR = 90 or higher)
Stage 2: Kidney damage with mild loss of kidney function (GFR = 89 - 60)
Stage 3a: Mild to moderate loss of kidney function (GFR = 59 to 45)
Stage 3b: Moderate to severe loww or kieney function (GFR = 44 to 30)
Stage 4: Severe loss of kidney function (GFR = 29 to 15)
Stage 5: Kidney failure (GFR = Less than 15)
Additional notes:
Your GFR number tells you how much kidney function you have. As kidney disease gets worse, the GFR number goes down.
An eGFR below 60 for three months or more, or an eGFR above 60 with kidney damage (marked by high levels of albumin in your urine) means chronic kidney disease. Your healthcare team will want to find the cause of your kidney disease and continue to check your kidney function to help plan your treatment.
Please note that the eGFR normally declines with age. A low eGFR in an older person does not always mean CKD, even if the eGFR is less than 60.
When you get an eGFR test, a simple urine test called the uACR will also be done to check for blood or albumin (a type of protein) in the urine. When you have albumin in your urine it is called albuminuria. Blood or protein in the urine can be an early sign of kidney disease.
Based on your eGFR and UACR, your healthcare team may also do one or more of these tests:
Imaging, such as an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your healthcare team whether your kidneys are too large or too small, whether you have a problem like a kidney stone or tumor, and whether there are any problems in the structure of your kidneys and urinary tract.
A kidney biopsy, which is done in some cases to check for a specific type of kidney disease. This test shows the type and amount of kidney damage there is, which helps with planning treatment. To do a biopsy, the doctor removes small pieces of kidney with a needle and looks at them under a microscope.
Your healthcare team may also ask you to see a kidney doctor, called a nephrologist, who will consult on your case and help manage your care.
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Alanine-aminotransferase (ALT, SGPT), Albumin, Serum, Albumin/Globulin (A/G) Ratio, Alkaline Phosphatase (ALP), Aspartate-aminotransferase (AST, SGOT), Bilirubin Total, Blood urea nitrogen (BUN), BUN/Creatinine Ratio, Calcium, Serum, Carbon Dioxide (CO2), Chloride, Serum, Creatinine, Serum, eGFR - Estimated Glomerular Filtration Rate (African Am), eGFR - Estimated Glomerular Filtration Rate (Non-African Am), eGFR / Cystatin C, Globulin, Serum (aka Globulin, Total), Glucose, Glucose Non-Fasting, Intestinal Isoenzymes (Alkaline Phosphatase), Potassium, Serum (Kalium), Sodium, Serum (Natrium), Total Protein, Serum
