Glomerular Filtration Rate (GFR) (Nursing)

00:01 Now let's look at the eGFR that stands for estimated glomerular filtration.

00:06 You can't really it's pretty complex to do an actual GFR.

00:10 That's why we use an estimate includes the serum creatinine.

00:14 Now it's impacted by lots of things.

00:16 So your GFR is impacted by how old you are the older you get the lower it gets.

00:23 Sex in body size also play a role.

00:27 So it's usually higher for men than it is with women.

00:30 And and it decreases with age.

00:33 Okay, let me pause for just a minute.

00:34 So the estimated glomerular filtration rate we're talking about the rate that that glomerulus is functioning, right? Usually higher in men than women and it decreases with age.

00:47 130 milliliters a minute is what you'll see in men, 120 for women.

00:53 So we remember, men serum creatinine was a little bit higher and also their GFR is a little bit higher just to keep that in mind.

01:01 Why do we care? Well, this is how we kind of communicate amongst each other as Healthcare Providers about what stage of kidney impairment the patient is at.

01:11 Now if the GFR is greater than 90 that's just stage one.

01:15 It's normal or a high GFR.

01:16 Okay stage 2.

01:18 Oh, hey, let me tell you do not memorize these, this is just to give you a concept of this is one of the ways that we use GFR.

01:26 I would not recommend getting ready for a test that you would have these.

01:30 Straight up memorized.

01:31 I just want you to have this as a frame of reference.

01:34 So you've got stage one and see how the kidney is mostly dark grey with just a little bit of like right on the top.

01:41 Stage 2.

01:41 We consider that mild chronic kidney disease, Their GFR is running about 60 to 89.

01:47 Now stage 3 has an A and B, see 45 to 59 or 30 to 44.

01:54 So see how the kidney the gray area is getting larger in the kidney to help your brain recognized.

02:00 That stage 3 is definitely worse than stage 1.

02:04 You have a lower and slower glomerular filtration rate in stage 3 that you would in stage 2.

02:10 So if you thought stage 3 was problematic look at stage 4.

02:14 What's the GFR in stage 4 for severe chronic kidney disease, Right. 15 to 29.

02:22 Now think back.

02:23 What is the normal GFR for a man or for a female? Yeah, definitely above a hundred even if you didn't remember that.

02:34 Stage 5 is really severe circumstances.

02:38 This is end-stage chronic kidney disease.

02:41 You have a GFR that's less than 15.

02:45 So this is someone who's probably needing some other type of severe kidney intervention, dialysis, peritoneal dialysis, hemodialysis.

02:53 We're having to do something major at this point because the kidneys are not able to keep the patient safe.

02:59 So major takeaway points from this slide.

03:02 We look at stages of chronic kidney disease from stage 1 to Stage 5.

03:08 The higher the number the lower the GFR.

03:11 That's the main concept.

03:12 We want you to take away from this.

03:14 Now, beyond GFR remember it's an estimate to what degree and extend the kidney function is impaired and will help us know what we should do as we're following the progression of the disease.

03:24 The GFR doesn't tell us how the kidneys were damaged or why.

03:29 It just tells us mmm, here's how the kidneys are function much like a blood pressure.

03:35 If we take a blood pressure, We're going to get a reading and it's going to tell us if your blood pressure is high low or normal, but it doesn't tell us why it's high doesn't tell us why it's low, doesn't tell us why it's normal.

03:45 We have to do some further investigating for an abnormal reading.

03:49 Same thing with GFR.

03:51 It tells us "Excuse me. You got a problem." "Stage 4, You got a real big problem." "Stage 1, Let's pay attention and see if we can really help the patient make any lifestyle changes and the physician will prescribe medications that may also help us prepare delay the progression of the disease.

04:07 So if we're looking at an overall picture of a patient's kidney function, they'll look at a full urine analysis, they'll measure urinary protein excretion.

04:18 And if necessary, they'll do some real logical studies or some a kidney biopsy.

04:22 So that is some hardcore assessments.

04:26 Your analysis all the parts of it.

04:28 Look at at urinary protein excretion and if it's necessary to figure out what exactly is going on, we'll look at radiologic studies and or do a kidney biopsy.

04:39 I want to talk a little bit more about GFR and what a normal GFR represents.

04:44 Now, we know the actual GFR is really hard to measure so we use an estimate.

04:49 That's when you see that little "e" in front of the GFR.

04:52 Now in order to calculate it we use the serum creatinine, patients age, patient's body size and their gender.

04:59 Now take a look at that dial.

05:01 You see we've got three main sections.

05:04 Over on the right, You've got between 60 and 120 that's considered a normal GFR.

05:10 Kidney disease is when the GFR drops lower than 60 and in fact actual numbers aren't even reported until the eGFR is less than 60.

05:20 So if you don't see a number that's probably because it is higher than 60 Now over in the red. That's the really sad part.

05:28 Less than 15 GFR that means we're in kidney failure.

05:32 So this patient is having to have some major interventions like peritoneal dialysis or hemodialysis.

05:38 So this was put here just to kind of give you an idea of what we're looking at.

05:43 Rather than memorizing all these different categories.

05:46 This may be a much more simpler way for you to approach eGFR.

05:49 Know that it doesn't even get reported until less than 60.

05:53 That's when we say, through kidney disease is kind of started to kick in once we get lower than 15 that's severe kidney failure.

06:02 So I would remember less than 60 starts to be a problem less than 15.

06:06 That is severe kidney failure.