How to Diagnose and Manage Chronic Kidney Disease

NICE Guidelines have been updated on the diagnosis and management of Chronic Kidney Disease (CKD).

The key points are:

Diagnosis:

1. Creatinine levels alone are crude to assess CKD
2. Creatinine clearance is better- with CKD-EPI calculators, unless the calculated function (eGFR) is 45-59 ml/min/1.73m2, in which case eGFRcytostatinC should be used
3. Look at Urine albumin/creatinine ratio (>3mg/mmol is bad)
4. Look at urine sediment for haematuria, red cell casts, white cell casts, fat casts, tubular cells
5. Do not diagnose CKD if:
   1. eGFR Creatinine 45-59 mlmin/1.73m2 and
   2. eGFRCytostatinC is >60ml/min/1.73m2 and
   3. no marker of kidney disease
6. Look for CKD in:
   1. Diabetes Mellitus
   2. Hypertension
   3. Any cardiovascular Disease
   4. Prostate disease, renal disease, stones
   5. systemic disease such as Lupus
   6. if hematuria detected
   7. acute kidney injury
   8. family history of end stage renal disease
7. Do a Renal Ultrasound if:
   1. Family History of Adult Polycystic Kidney Disease (APKD)
   2. Haematuria
   3. Symptoms of renal tract obstruction
   4. eGFR <30ml/min/1.73m2

Treatment:

1. Anti-Hypertensive
   1. Target BP <140/90
   2. Target BP <130/80 if diabetes, or albumin/creatinine ratio >70mg/mmol.
   3. Use HT guidelines if Albumin/creatinine ratio <30mg/mmol, and not diabetic.
   4. Use low cost ACEI or ARB 1st line if:
      1. Diabetes and albumin/creatinine ratio> 3mg/mmol
      2. Hypertension and urine albumin/creatinine ration>30mg/mmol and NOT diabetic
      3. urine albumin/creatinine ratio >70 mg/mmol even if no diabetes and no hypertension.
2. Offer anti-platelest as primary prevention of cardiovascular events
3. Although not mentioned in the BMJ article, I would favour statin therapy as primary prevention also. Atorvastatin 10mg is a good start.

More information is available direct on line or via the BMJ summary.

Dr Malik