Screening and Diagnosis of Chronic Kidney Disease

exp date isn't null, but text field is

 

 

Patients at risk:

  • Diabetes
  • Hypertension
  • Acute kidney injury (minor patients for CKD for at least 3 years after AKI, even if serum creatinine returned to baseline)
  • Cardiovascular disease
  • Structural renal tract disease, recurrent renal calculi, prostatic hypertrophy
  • Multisystem disease with potential kidney involvement - e.g. SLE
  • Family history of ESRD (GFR category CKD5) or hereditary kidney disease
  • Opportunistic detection of haematuria
  • Nephrotoxic drugs - lithium, NSAIDs, ACEI, ARBs, ciclosporin, tacrolimus

Urology Guidelines

Management of Chronic Kidney Disease

Acute Kidney Injury Guideline

Proteinuria

Do not use reagent sticks to diagnose proteinuria

Urine albumin:creatinine ratio (ACR) is more sensitive than urine protein:creatinine ratio at low levels of proteinuria

ACR will be used for screening. A normal result is ACR < 3 mg/mmol

Proteinuria is not an indication for urine culture in the absence of symptoms of UTI

In patients with symptomatic UTI the test for proteinuria should be delayed until after UTI resolved

If urine ACR > 70 mg/mmol, a protein:creatinine ratio will be checked

Testing for Haematuria

When testing for haematuria use reagent strips rather than urine microscopy.

Presence of haematuria in 2 out of 3 reagent strip tests confirms persistent invisible haematuria

Persistent invisible haematuria with or without proteinuria should prompt investigation for urological malignancy in those age > 50

Persistent invisible haematuria with proteinuria should be followed up annually with repeat testing for haematuria, ACR, GFR and BP as long as haematuria persists.

Frequency for monitoring of GFR

Frequency for monitoring of GFR (number of times per year, by GFR and ACR category for people with or at risk of CKD

GFR Category ACR Categories (mg/mmol)
A1 <3 normal to mildly increased
ACR Categories (mg/mmol)
A2 3-30 moderately increased
ACR Categories (mg/mmol)
A3 >30 severly increased
G1 >90 normal and high <1 1 >1
G2 60-89 mild reduction related to normal range for young adult <1 1 >1
G3a 45-59 mild-moderate reduction 1 1 2
G3b 30-44 moderate-severe reduction <2 2 >2
G4 15-29 severe reduction 2 2 3
G5 <15 kidney failure 4 >4 >4

This should be tailored according to:

Editorial Information

Next review: 31 March 2017

Author(s): Renal MDT

Version: 1

Approved By: high-uhb.tam@nhs.net

Reviewer Name(s): Dr Nicola Joss with Drs Lambie, Peel and McDonald