Testing for urinary protein
Management of Chronic Kidney Disease (CKD)
*At all stages of CKD the key is good cardiovascular risk control*
Definition of CKD:
CKD is defined as abnormalities of kidney function or structure present for more than 3months, with implications for health. This includes all people with markers of kidney damage and those with a glomerular filtration rate (GFR) of less than 60ml/min/1.73m2 on at least 2 occasions separated by a period of at least 90days (with or without markers of kidney damage).
Markers of CKD include albuminuria (ACR more than 3mg/mmol), urine sediment abnormalities, electrolyte and other abnormalities due to tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging, and a history of kidney transplantation.
If a GFR of 6.5 mmol/L) | Nephrotic syndrome (peripheral oedema, >3g proteinuria and |
| |hypoalbuminaemia (Alb 70 mg/mmol or PCR >100mg/mmol) unless known to be | Proteinuria (ACR >30 mg/mmol (ACR category A3) or PCR >100mg/mmol) |
|caused by diabetes and already appropriately treated |and invisible haematuria |
| Hypertension that remains poorly controlled despite the use of at | Suspected renal artery stenosis (GFR increase from pretreatment |
|least 4 antihypertensive drugs at therapeutic doses |baseline is >25% or the serum creatinine increase from baseline > 30% after |
| |the initiation of ACE-I/ARB therapy) |
| Suspected renal anaemia with GFR less than 45 mL/min/1.73m2 & Hb less| Known or suspected rare or genetic causes of CKD such as autosomal |
|than 110 g/L |dominant polycystic kidney disease and systemic diseases such as ANCA |
| |vasculitis and SLE |
| |
CKD stage of the referral:
|G1 (>90mL/min) |G2 (60-90mL/min) |G3a (45-59 mL/min) |
| | | |
| | | |
|G3b (30- 44 mL/min) |G4 (15-29 mL/min) |G5 ( ................
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