Beruflich Dokumente
Kultur Dokumente
Test Urine
Persistent
proteinuria >1+
ACR 30 / PCR 50
Microalbuminuria
If hypertensive
consider ACEi/ARB
BP control - ACEi/ARB
Refer
Nephrotic range
Urgent Referral
CKD 1 or
eGFR > 60
Check eGFR
eGFR 45 59
eGFR 30 - 44
eGFR 15 29
CKD 3A
CKD 3B
CKD 4
2
eGFR >60 normal unless
evidence of kidney disease
(structural abnormality
eGFR <15
CKD 5
Severe decrease in
GFR +/- other evidence
of kidney damage
Established renal
failure
Blood Pressure, Creatinine and eGFR, Hb, Urine Protein Creatinine Ratio (PCR)
Other
Investigations
Potassium,
Calcium ,
+
Phosphate
Bicarbonate,
Vitamin D,
PTH
Repeat
within 5 days
Creat >2x baseline
6 monthly
3 monthly
Refer acute
medicine
Creat >3x baseline
Mineral metabolism
is disturbed in most
patients with CKD4/5:
25 OH Vit D:
If less than 75 nmol/l
Calceos / Adcal D3 2 tabs
daily or cholecalciferol
20,000 iu weekly
Stop ACEI/ARB if
hyperkalaemia persists
References
This pathway based on the North Central London CKD Guide 2011
DOH 2005 - NSF for renal disease
RCP National Collaborating Centre for Chronic Conditions - CKD Guidance
The Renal Association - UK CKD Guidelines
Clinical contact for this pathway: Dr John Connolly johnconnolly@nhs.net
Comments & enquires relating to medication: NHS Camden Medicines Management Team mmt.camdenccg@nhs.net
Refer to current BNF or SPC for full medicines information
Stage 4 or 5 CKD
Refer RFH
renal unit
AKI phone
07908422116
CICS Referral
Malignant hypertension
Hyperkalaemia
(K+ > 7 mmol/L)
Nephrotic syndrome