CKD

Question 1

Value of eGFR that requires referral to a nephrologist from primary care

Answer 1

eGFR falls below 30 or progressively by >15 in a year

Question 2

Reasons to refer to nephrology

Answer 2

eGFR of less than 30/ml/1.73m2
- Sustained decrease in eGFR of 25% or more and a change in GFR category or sustained decrease in eGFR of 15ml/mil/1.73m2 or more within 12 months
- A urinary albumin:creatinine ratio (ACR) of 70 mg/mmol or more, unless proteinuria is known to be associated with diabetes mellitus and is managed appropriately.
A urinary ACR of 30 mg/mmol or more together with persistent haematuria, after exclusion of a urinary tract infection (UTI).
Hypertension that remains uncontrolled despite the use of at least four antihypertensive drugs at therapeutic doses.
A suspected or confirmed rare or genetic cause of CKD, such as polycystic kidney disease.
Suspected renal artery stenosis.
A suspected complication of CKD.

Question 3

4 variables used to estimate GFR

Answer 3

Serum creatinine 
Age
Gender
Ethnicity 
(Pregnancy, muscle mass and eating red meat may affect the result)

Question 4

CKD stages according to GFR

Answer 4

1) greater than 90ml/min with some sign of kidney damage on other test
2) 60-90 ml/min with some sign of kidney damage
3a) 45-59 ml/min a moderate reduction in kidney function
3b) 30-44 ml/minn, a moderate reduction in kidney function
4) 15-29 ml/min, a severe reduction in kidney function
5) less than 15ml/min, established kidney failure- dialysis or