Q: I am 35 years old and was diagnosed with hypertension (180/120 mmHg) and put on Amlodipine. Doctor suspected secondary hypertension and did a series of renal (renal doppler, serum electrolytes, microalbuminuria, etc.), heart (ECG, ECHO, Lipid Profile) and other organs tests. The results were normal except that the GFR of the left kidney was 80 and right kidney was 15. However BUN, creatinine (0.8), serum electrolytes everything was normal. My right kidney is very small and this was detected when I was 5 years old. The scan now shows no hypdronehrosis or any other issue. I am worried because of GFR is 15 which would classify me as chronic kidney disease level 4. Am I really heading towards kidney failure? How can I protect my kidneys from deterioration?

A:Glomerular filtration rate signifies cumulative filtering function of both the kidneys. In your case, it seems that you have normal filtering function all of which is being accounted for by left kidney with minimal contribution from right kidney. Your history does clarify that you probably have had either a congenital anomaly (since birth) or a early childhood disease involving the right side urinary outflow tract / kidney, which could have resulted in significant loss of kidney function and small sized kidney. Other possibility though less likely at your age could be blockage of arterial flow to the right kidney (called renal artery stenosis) which can result in small sized kidney with loss of function along with significantly elevated blood pressure(BP). You are not heading towards kidney failure nor can you be classified as having stage IV chronic kidney disease. Instead, the focus should remain on achieving strict BP control with target BP being <130/80 mmHg. Also, you are advised to undergo urine tests to look for increased leakage of protein which is a sign of early kidney damage in someone who has well preserved GFR.