00:00
Let's talk about a normal GFR
because remember
actual GFR is really
particular to measure
its kind of cumbersome.
00:08
So we use an estimate.
00:10
That's a calculation of fancy
math using serum creatinine,
age, body size, and gender.
00:18
Now, I've heard someone call this a
taco and that is a pretty good example.
00:23
I'm from the southwest,
we love our tacos.
00:25
So wherever you
are, you may too.
00:28
When you're remembering this in your
mind, look at this and remember our taco.
00:33
Look at what's right
in the middle there.
00:36
Okay. So we've got that
yellow piece actually looks
like the color of a taco shell.
00:42
120 - 60 if the GFR is 120-60
that's considered normal.
00:47
When you look at
your patients lab results,
you won't even see a number
reported unless it's less than 60.
00:53
So if you get GFR back,
there's no number, don't panic.
00:56
Know that it means it's normal.
We're right within that range.
00:59
We're not going to
see an actual number.
01:02
Now, let's move to the middle
chunk between the 60 and 15.
01:07
If it's less than 60, we likely have
some kidney disease going on.
01:12
Now you can have kidney disease,
you can have
damaged your kidney,
before your patient even
realizes that it's happening.
01:20
Now, look at that last
chunk we've got it in red.
01:23
Because the problem
there is that's kidney failure.
01:26
If it's less than 15 we have definite
kidney failure and huge issues.
01:32
Okay, so it looks like a taco but
look at the colors, green, yellow, red,
just like a stoplight.
01:40
So if you're in that first
range, 60 to 120, normal.
01:44
Everything's fine, green light.
01:46
If you're in the 60 - 15
range, okay, we're on guard
because we're thinking
this might be an acute issue,
this could be a chronic issue.
01:54
We're keeping an eye on it.
01:55
And the closer
you tick towards 15,
we're in big trouble,
that's the red zone, 0 to 15.
02:03
So when you're trying to remember
these values for practice and for exams,
picture the taco, think, green, yellow,
red, and the number should be easier
for you to remember.
02:16
Okay, let me give you some
values up on the screen for you again.
02:20
Now, here's a lot of words,
but you already have laid the
groundwork in your brain to remember this.
02:25
So normal estimate
GFR for patients is?
There you go.
02:31
Look what we're looking for.
The actual numbers are noted only
when the patient
is less than 60.
02:37
So you won't see
numbers on your results.
02:41
Okay, so men and
women here we go again.
02:43
We're talking about
glomerular filtration rate.
02:45
You know, in other lab work we've noted
like creatinine that dealt with muscle,
it was a little higher
in men than women.
02:52
GFR, it's also a
little higher for men.
02:55
Look at that a rate of 130.
02:58
Then women is 120.
03:00
I would just use the 120 number
that we gave you on our taco
and you'll have a
great chance of keeping
that solid in your brain for
memory on tests and in practice.
03:11
Now, as you age GFR changes.
03:14
Look if I was 24 years
old, look at our chart,
what would your average eGFR be?
Right, 116.
03:22
Now, as I move through my
30s, look it drops down a little bit.
03:25
What's the number?
Right, 107.
03:29
Hey, hang with me.
03:30
Sometimes when you can answer
a question right in nursing school,
it's a win, just take it baby.
03:34
It's a win.
03:35
All right. Now, I'm in my 50s.
03:38
Look at my GFR.
03:39
Okay, 93. Compare that
in my 20s, which was 116.
03:45
So just want you to
keep in mind as you age
that GFR through the process
of aging is going to decline
that's why age needs
to be part of the formula.
03:57
So look at this overview.
03:59
We've got GFR as a specific
measure of chronic kidney disease.
04:04
Now, before we go anything else,
I want you to write in what
kind of GFR would you want.
04:09
Just point with your finger.
You don't have to write it in.
04:11
Point with your finger what range
would you want to be in as far as GFR?
Yeah. Hopefully you're
pointing in the green range, right?
We like to be be in a
perfectly healthy strong kidney.
04:21
Now, as it progresses, as kidney
disease progresses and as we age,
which way would
your finger move?
Right, you be moving away from 120
closer to 60, closer to the yellow zone.
04:35
Good deal.
04:36
If you can track that with me your
understanding the concept and that's spot-on.
04:40
That's what we're looking for.
04:42
So GFR greater than or equal
to 60 is considered normal.
04:47
We know that less than 60 means
we're heading towards kidney disease.
04:51
And GFR less than 15
is an urgent emergency.
04:56
Now, I'm going to show you the
stages of chronic kidney disease.
04:59
Are you with me?
Don't memorize this.
05:02
I just want you to see
this as a reference.
05:04
So we've got five stages.
05:07
Stage one: Look at that normal
GFR or is least greater than 90
Stage 2: Hey, you're
still within normal,
but you've got mild
chronic kidney disease.
05:19
Hey, this is a rough conversation
to have with somebody
to say, "Hey, I know you
don't know there's a problem,
but we need to keep
an an eye on this."
Now, look at the two kidneys.
05:28
See the first one in stage one
how it's all pretty much dark-colored?
That is stage two.
05:35
That's representing we have
fewer functioning nephrons.
05:38
Yeah. There we go.
05:40
Stage 3A: Now it's progressing.
05:42
The numbers are getting lower and we
have less of a kidney that's working well.
05:47
Stage 4:Now, we're in
severe kidney disease.
05:51
and Stage 5.
05:53
So when you see patients
come in and they have a diagnosis
of stage 3 chronic
kidney disease,
this is exactly what
they're talking about.
06:00
This is the criteria.
06:01
Do I want you to memorize this?
No, you don't have enough real
estate in your brain to memorize this.
06:08
You do have enough real estate to remember
taco, red, yellow, green, 120, 60, 15.
06:15
That anybody can do.
06:17
This is information you can
look up when you need it.
06:21
Just keep in mind stage
one, super. Stage 5, yikes.
06:25
We're on some type
of dialysis in Stage 5.