Creatinine/BUN Ratio?

[xRavenHeartx]

Hello, 

    First time posting here. I am a 40 year old female, and have been suspecting for a while now that I may have celiac disease, or at least some level of gluten sensitivity. (I have never brought it up to my doctor, however.) A few days ago my pcp did some bloodwork on me, and I saw the results on their online patient portal but it says my doc has not viewed it yet. They show that I have a vitamin D deficiency, as well as a very low creatinine/bun ratio. While I know that the D deficiency is common in people with celiac, I am not sure if the creatinine/bun ratio being too low could have any connection or not. Does anyone know anything about this and if the two could possibly be connected? I believe that a low creatinine/bun ratio is connected to a low protein intake or malnutrition, but I am a very healthy eater and get plenty of protein. So could this be due to the intestines being damaged from celiac? Thank you so much for any and all advice.

[trents]

Look in your recent bloodwork results and see if there are lines for albumin and total protein.

[Wheatwacked]

Hello xRavenHeartx,

Quick weight loss in a person with low BMI can cause lower eGFR.  eGFR is inversely related to high BUN/creatine.  Happened to me, it can recover.  Oddly in the same study researchers found that rapid weight loss in a person with high BMI will experience higher eGFR and normal BMI show no change.

Meds can cause it, too.

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          The BUN:creatinine ratio is a helpful calculation. Traditional teaching states that hypovolemia should be considered if the ratio is higher than 20:1. A ratio of more than 30:1 should prompt concern for an upper gastrointestinal bleed

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If he is planning on an endoscopy ask them to take biopsies for Celiac Disease at the same time.  Get blood tested for Celiac Disease.  You are right it could be malnutrition due to villi damage.  In any case, don't freak out, malnutrition is reversable.  Ask doc about a vitamin D injection to speed things up.  Maybe an infusion of B vitamins. 

Low vitamin D is associated with kidney function.  Ravani et al. showed that serum 25(OH)D was an independent inverse predictor of kidney disease progression

Did he do a homocysteine test?. eGFR? Homocysteine is considered an independant indicator of cardiovascular disease.   

What is the Difference Between sCr, eGFR, ACR, and BUN?

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      BUN to creatinine ratio

The ideal ratio of BUN to creatinine falls between 10-to-1 and 20-to-1. Having a ratio above this range could mean you may not be getting enough blood flow to your kidneys and could have conditions such as congestive heart failure, dehydration, or gastrointestinal bleeding.  A ratio below the normal range could mean liver disease or malnutrition.

 

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[Scott Adams]

Feel free to share the blood test results here along with the reference ranges for each test. That would be very helpful.

[plumbago]

Hi @xRavenHeartx, I have not had a low BUN/creatinine ratio, but on occasion my ratio has been high. I puzzled over it a while - the notes I took based on my research of this topic said 1) some labs do not do ratios if each component is within normal limits; 2) "high ratio could mean decreased blood flow to kidneys. If 30 (mine was 26 at the time), could be HF, dehydration, increased protein or GI bleed." - before I decided that I'm not gonna worry about it. At any rate, your ratio was low not high. I think somewhere in my notes (for patients), I wrote for low ratio to check liver enzymes if this happens, and malnutrition could be to blame.

Pfft.

Frankly, I would not sweat it, but if you are worried, for sure talk to your doc.

Plumbago

[Wheatwacked]

  On 11/20/2023 at 12:48 AM, plumbago said:

for low ratio to check liver enzymes if this happens, and malnutrition could be to blame.

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              A diet restricting liver, eggs and steak will be deficient in Choline. Choline deficiency is proven to cause Non Alcoholic Fatty Liver Disease in non alcoholics, and Fatty Liver Disease in alcoholics.  Supplementing with choline to at least the recommended intake and other B vitamins is cheap, safe, and may help.  It will not hurt, and may save the need for more diagnostics.  

[plumbago]

I have never heard of that @Wheatwacked.

To clarify, I've never heard of someone eating low on the glycemic index and deficient in choline who has NAFLD. In my work and informal research, overwhelmingly implicated in NAFLD is the usual American (or increasingly Western) bugaboo: sedentary lifestyle and overconsumption of sugar. Risk factors are the usual ones, such as poor diet, and fat in the abdominal area.

[Wheatwacked]

They do try to blame us for their bad advice over the last fifty years.

Could we be overlooking a potential choline crisis in the United Kingdom?

Here's an oddity that happened to me today:

• At 1 pm my blood sugar was 203 mg/dl.
• I had 195 grams of egg (3 jumbo), 560 mg choline;108 grams pork breakfast sausage, 76 mg choline.
• At 4 pm my glucose was 107 mg/dl.

That's the first time in 2 1/2 years my glucose has been below 125 mg/dl.  Normally on low carb the longer I fast, the higher it goes.  Lately I've found adding sugar, lowers my glucose.  Except for high triglyerides and cholesterol my bloodwork is perfect.  Homocysteine is ranges between 14 and 25. Below 18 is normal, no indications of cardivascular inflammation. 

 

Some research on choline

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        Choline Metabolism Provides Novel Insights into Non-alcoholic Fatty Liver Disease and its Progression  Key points

• Choline is an essential nutrient with multiple mechanistic roles in NAFLD and its progression including VLDL export, enterohepatic metabolism of bile, mitochondrial function, epigenetics, ER Stress, and VLDL export.
• Choline deficiency in humans is associated with liver dysfunction and susceptibility is dependent on factors, including genetics, gender, and the gut microbiome, which influence choline requirements.
• Recent evidence has identified a prominent role for choline and one carbon metabolism in metabolic syndrome.
• Applying knowledge of individual choline requirements into gastroenterology clinical practice has the potential to improve outcomes.

 

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 The Addition of Choline to Parenteral Nutrition

However, in the patient with intestinal failure, choline bioavailability from the diet is decreased markedly as a result of malabsorption.  Choline deficiency in human beings results in hepatic aminotransferase abnormalities and hepatic steatosis. This is owing to deficient very low density lipoprotein synthesis, with a resultant decrease in triglyceride transport out of the liver. A significant inverse relationship was observed between plasma-free choline concentration and both ALT and AST levels.  Methotrexate, an inhibitor of the enzyme dihydrofolate reductase, results in decreased availability of folate as a methyl donor, and is associated with the development of hepatic steatosis, and, in later stages, fibrosis. Choline supplementation reverses the methotrexate-induced steatosis in rats. There are currently no available human data.

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[plumbago]

I don't really understand what you're saying, except to say that on a population level, the incredible rise of added sugars in our diets are directly linked to the crazy rise in NAFLD. I have never heard of choline deficiency as the cause of the NAFLD epidemic.

And, if you are avoiding (added) sugars, yes, your blood glucose could slowly rise due to the lack of insulin activation, so introducing some sugar would trigger release of insulin which then clears out a lot of the circulating glucose in the blood. I would not be happy if my BG had not been below 125 in two and a half years @Wheatwacked!

[Wheatwacked]

Sorry if I am confusing.

No, choline alone is not going to fix the Western Diet.  But add Celiac Disease malabsorption in a recovering Celiac to the fact that 90% of the general population eat less than Adequate Intake; if liver enzymes are off and the dotors are saying maybe it is this or could be that or just telling you don;t worry be happy; maybe it is simply choline deficiency. The fastest and cheapest way to find out would be to spend $20 bucks on a choline supplement for a few months and see how it changes the enzymes.  Even if it does not affect the liver enzymes it a) possibly eliminates choline as a potential cause and b) will probably benefit one of the many other systems choline is essential to.  In any case, no harm done.

          Dietary choline intake and non-alcoholic fatty liver disease (NAFLD) in U.S. adults: National Health and Nutrition Examination Survey (NHANES) 2017–2018  Conclution: With the latest NHANES data, we found that higher dietary choline was associated with a lower risk of NAFLD in American adults, and such a relationship exists in both females and males.

 

[Wheatwacked]

  On 11/21/2023 at 2:54 AM, plumbago said:

I would not be happy if my BG had not been below 125 in two and a half years

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During that period my physical and mental health has improved.  Metformin turned me into a zombi.  Others have had no effect, at best.

[xRavenHeartx]

  On 11/19/2023 at 7:45 PM, Scott Adams said:

Feel free to share the blood test results here along with the reference ranges for each test. That would be very helpful.

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These are my test results, if this helps anyone out pertaining to my situation-

FUrea Nitrogen (BUN) is 4, reference range is 6-19.

FBUN/Creatinine Ratio is 5.5, reference range is 10-28.

FChloride is 97, reference range 98-108.

So as you can see, the Creatinine/BUN ratio was the lowest. Does this help give anyone an idea what I’m dealing with here, or if there could be any connection to celiac or not? 
Thanks so much for the responses!

[plumbago]

What is your creatinine?

[xRavenHeartx]

  On 11/21/2023 at 5:25 PM, plumbago said:

What is your creatinine?

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My creatinine by itself is 0.73, which looks like it falls within normal range.

[xRavenHeartx]

I have an appointment to see my doc next week to discuss the results, and would like to know if I should ask for a celiac blood test, and if that could possibly be connected to this in some way. I think I will ask for one regardless, because I have many other symptoms which is what led me here. 
 

You guys are great btw, thanks so much for the replies.

[plumbago]

Thanks! Yes, definitely get a Celiac panel. If your insurance won't cover it, you can order one yourself (and pay, of course).

I haven't heard of a low BUN and (only) slightly low chloride being linked up to celiac disease, but I am not an expert. Low BUN may or may not be significant. Before making major clinical decisions, me myself - for sure I'd repeat the test. Decreased BUN has been linked to overhydration, as well as a couple of other things.

Plumbago

Editing to add: if you are trying to make a case for a paid-for Celiac test, your symptoms (if any) combined with the low vitamin D should be sufficient.

Edited November 21, 2023 by plumbago

[knitty kitty]

@xRavenHeartx,

What are some of your many other symptoms?