Renal GP Flashcards
Chronic kidney disease (CKD) - definition?
Chronic kidney disease (CKD) is an abnormality of kidney function or structure that is present for more than 3 months, with implications for health.
Chronic kidney disease (CKD) -
how do we measure it?
Both a
Blood test for serum creatinine, to calculate estimated glomerular filtration rate (eGFR), a test of renal function
and
Early morning urine for Albumin/Creatinine ration (ACR), a test for proteinuria.
Also
Dipstick the urine for haematuria.
In stages 4 and 5 also
monitor calcium, phosphate, Vitamin D and PTH, as well as haemoglobin.
CKD -
Albuminuria stages?
Albuminuria (Proteinuria) stages based on urine Albumin/Creatinine ratio (ACR, in mg/mmol)
<3 = mildly increased = A1
3-30 = moderately increased = Microalbuminuria = A2
>30 = severely increased = Proteinuria = A3
CKD -
renal function stages?
Renal function stages based on eGFR:
>90 = normal
60-89 = mild reduction
45-59 = mild-moderate reduction = CKD stage G3A
30-44 = moderate-severe reduction = CKD stage G3B
15-29 = severe reduction = CKD stage G4
<15 = kidney failure = CKD stage G5
QOF: keep a register of patients with CKD stages 3, 4 and 5
CKD -
when to refer?
- eGFR <30 = Stages 4 or 5 (with or without diabetes)
- ACR >70
- ACR >30 with Haematuria
- Decline of 25% and change in GFR category, or of 15ml/min/1.73m2 in a year
- Poorly controlled BP despite 4 antihypertensives
- Rare or genetic causes of CKD
- Suspected renal artery stenosis (RAST)
- Complications like anaemia or renal bone disease
CKD -
when to prescribe an ACE Inhibitor?
Prescribe an ACE Inhibitor in CKD with
- Diabetes + ACR >3
- Hypertension + ACR >30
- ACR >70
Avoid ACE if potassium >5, and stop again if >6
A decrease of eGFR of 25% or Creatinine of 30% after starting ACE would be acceptable
CKD -
blood pressure targets?
CKD: < 140/90
CKD + diabetes: < 130/80
CKD + ACR >70: < 130/80
