By Brittany Trang; Statnews
Even as a child, La’Tonzia Adams was interested in diagnosing disease. One day, when she noticed a bump on her chest, she decided to look up “chicken pox” in the Webster’s dictionary at her grandmother’s house to figure out if her symptoms matched the illness.
“I remember I scratched it, and it was watery,” said Adams. “When I looked up the chicken pox, I remember seeing ‘watery filled vesicle.’ I didn’t know what ‘vesicle’ was, so I looked up ‘vesicle’ in the book,” she added with a laugh.
“When my mom came to my grandmother’s, I said, ‘Mother, I believe I have chicken pox.’” Her mother argued with her, but Adams turned out to be right about her self-diagnosis.
Adams is now a staff pathologist and director at the Veterans Affairs Portland Health Care System in Oregon. But even though her job is to “have knowledge of disease from head to toe, inside and out,” she couldn’t diagnose her own father’s end-stage renal failure — partly because the metrics wouldn’t have allowed her to.
For decades, health care providers have diagnosed kidney disease with blood tests that use an equation for estimating glomerular filtration rate, or eGFR — a number that acts a proxy for how much blood the kidneys clean every minute. Until recently, the eGFR equation has included a coefficient for race to “correct” for different levels of creatinine (a waste product released from muscles) in African Americans. This adjustment was based on the incorrect assumption that Black people have higher muscle mass. Black people were therefore assumed to have higher baseline eGFR levels, which could in turn mark them at a less advanced stage of kidney disease even when their numbers are the same as a non-Black person’s.
But in 2021, an expert panel recommended a retooled eGFR equation that leaves out race and was recalculated using data from a diverse group of subjects. On Tuesday, the College of American Pathologists (CAP) published in the Journal of the American Medical Association the results of a survey that explores how many laboratories across the country have adopted the new equation, endorsed by the National Kidney Foundation and the American Society of Nephrology as well as nine pathology and laboratory societies.
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