CKD investigations and management Flashcards
What is normal eGFR?
100-130
What can you not do 12hrs before an eGFR?
Eat red meat
What is the steps for repeating an eGFR?
- eGFR <60
- Repeat test within 2 weeks
- If eGFR remains <60 + no evidence of sudden deterioration in renal function (AKI), repeat eGFR in 3 months
What groups can eGFR be prone to error in?
- Extreme body types (amputees, severely malnourished and morbidly obese)
- Pregnancy
- Black patients need to multiply the formula to correct it
- The creatinine level must be stable
What can measure true eGFR?
- Insulin clearance
- Isotope GFR
- Urea
- Cystatin C
What is a normal ACR?
< 3mg/mmol
When would you repeat or not repeat an ACR?
3-70mg/mmol
• Repeat test within 3 months
≥70mg/mmol
• Repeat test not needed as this indicated significant proteinuria
What are indications for HTN treatment with an ACEi/ARB?
- ACR ≥3mg/mmol + DM
- > 30mg/mmol + HTN
- All patients + >70mg/mmol
Who has a BP target of <130/80 on HTN treatment?
• ACR ≥3mg/mmol + DM
Who has a BP target of <140/80 on HTN treatment?
- ACR>30mg/mmol + HTN
* ACR >70mg/mmol
What is the general management of CKD?
- Manage complications
- Pneumococcal and influenzas vaccine
- BP control
When do you check creatinine and K+ after starting an ACEi/ARB?
2 weeks after starting/adjusting dose
When do you stop ACEi/ARBs?
o A fall in eGFR ≥15% = stop medication
o Stop ACEi/ARBs in hypovolaemia
What is the criteria for referral?
• eGFR <30
• ACR ≥70mg/mmol
• Accelerated progression of CKD
o Sustained increase in eGFR of ≥25% AND change in CKD category within 12 months OR sustained decrease in eGFR by 15ml/min within 12 months
• Uncontrolled HTN despite ≥4 antihypertensives
What permits immediate referral?
o Malignant HTN o Hyperkalaemia (>7mmol/L)
