Prevalence, Detection, Evaluation and Management of Chronic Kidney DiseaseBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7688 (Published 13 February 2014) Cite this as: BMJ 2014;348:bmj.f7688
- Penny Ackland1
- 1Nunhead Surgery Nunhead Grove South East London, UK
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It is important to be able to identify those with early chronic kidney disease (CKD), firstly because CKD has a very strong association with the risk of death, cardiovascular disease and hospitalization, and secondly, in order to attempt to prevent/delay the progression to end-stage renal disease (ESRD).
In relation to the management of CKD, important factors to consider are the rate of change of kidney function and whether there is proteinuria or haematuria. The presence of other comorbidities, current or recent drug history, family history and the age of the patient are additional factors that need to be taken into account.
If estimated glomerular filtration rate (eGFR) is <60 mL/min/1.73 m2 in the first test, retest within two weeks to exclude causes of acute deterioration of glomerular filtration rate (GFR).
Significant progression of CKD is defined as a decline in eGFR of >5 mL/min/1.73 m2 within 1 year, or >10 mL/min/1.73 m2 within five years.
All CKD patients should be checked for proteinuria.
In people without diabetes, albuminuria/proteinuria is considered clinically significant when the albumin:creatinine ratio (ACR) is ≧30 mg/mmol.
In people with diabetes, consider microalbuminuria of an ACR > 2.5 mg/mmol in men and >3.5 mg/mmol in women to be clinically significant.
A nephrological referral should be considered (a) if there is significant proteinuria (ACR ≧70, or protein:creatinine ratio (PCR) ≧ 100) with or without haematuria or (b) if the ACR ≧ 30 or PCR ≧ 50 with haematuria.
If a young adult has haematuria (cola-coloured!) and an intercurrent illness (usually an upper respiratory tract infection), they …