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DISEASE
SCREENING
AND
INVESTIGATIO
NS FOR CKD IN
PATIENTS WITH
DIABETES
SCREENING AND
INVESTIGATIONS
FOR CKD IN
PATIENTS
WITHOUT
DIABETES
Screening of general
population is not costeffective. It is only done
for people with high
risks for developing
CKD.
TREAT
MENT
FOR
CKD
Renal profile
should be
carefully
monitored
following
PROTEINURIA
Microalbuminuria
Urinary albumin excretion rate 20 200mcg/min/24h or 30-300mg/24h
Cannot be detected with usual urine dipstick
Earliest sign of diabetic kidney disease
HAEMATURIA
May indicate infection, renal calculi, primary
glomerulonephritis, malignancy
Isolated non-visible haematuria is associated with a modest
increased risk of progressive kidney disease
Positive dipstick test (1+ or more) for blood on 2 out of 3
occasions may warrant a microscopic examination
Presence of dysmorphic red blood cells and red cell casts
indicate glomerular disease
RENAL FUNCTION
Renal function should be
assessed with MDRD eGFR.
Serum creatinine should be used
in combination with eGFR in
assessment of renal function.
When eGFR is not available, other
methods of estimation may be
used.
STAGING (NKF-KDOQI)
Staging CKD is based on
GFR (level of kidney function)
Pathological changes (kidney damage)
Presence of abnormality for at least 3
months
Kidney damage is defined as either
Persistent microalbuminuria
Perisistent proteinuria
Persistent haematuria
Radiological evidence of structural
abnormalities of kidneys
Biopsy proven glomerulonephritis
TREATMENT TARGETS
Target BP <140/90mmHg (SBP range 120-139mmHg)
Target BP <130/80mmHg (SBP range 120-129mmHg)
In patients with proteinuria >1g/d
In patients with diabetic kidney disease
TREATMENT CHOICES:
OTHER DRUGS ON TRIAL
Renin inhibitor eg Aliskiren
Licensed as antihypertensive agent
Renoprotection effect not established
DIET
Low protein diet (0.6-0.8g/kg/d) with adequate energy intake
(30-35kcal/kg/d) may be given to patients with chronic kidney
disease stage 3-5
Dietary protein restriction should be supervised by a dietitian
due to complication of protein-calorie malnutrition associated
with a low protein diet
Sodium restriction (total intake <2,400mg/d) should be
initiated in patients with CKD
PREGNANCY
Pregnancy may be considered in women with CKD having
mild renal impairment (serum creatinine <124umol/L) and
well-controlled blood pressure
Women with moderate to severe renal impairment should be
counselled to avoid pregnancy due to greater adverse
maternal and fetal outcomes
Method of contraception used would depend on the
underlying cause of renal disease and associated comorbidities
REFERRAL
Immediate referral is indicated in
patients with
Acute renal failure superimposed
on CKD
Newly detected ESRF (GFR
<15ml/min/1.73m2)
Accelerated or malignant
hypertension
Hyperkalemia (serum potassium
>7mmol/L)
Suspected glomerulonephritis
When referring to a nephrologist,
ensure patient has a recent renal