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Love Kidneys

Applying clinical guidelines –
diagnosing and identifying
stages of CKD

✓ The presence of chronic kidney disease (CKD) is confirmed when clinical marker(s) are present ≥ 3 months.

  • Albuminuria: > 30 mg of urinary albumin per gram of urinary creatinine (UACR) and/or
  • eGFR: < 60 ml per minute per 1.73m2.

✓ Further evaluation is needed to determine the underlying cause to:

  • Identify acute, reversible, and/or treatable conditions,
  • Provide baseline data for both the primary care provider (PCP) and nephrologist, when consultation is needed, and
  • Include in the patient treatment plan.
Further Evaluation Once CKD is Detected
Initial evaluation may include: Further workup may include:
  • Glucose (A1c/eAG)
  • Blood urea nitrogen (BUN)
  • Electrolytes
  • Calcium
  • Phosphorous
  • Fasting lipid panel
  • Complete blood count (CBC)
  • Renal ultrasound
  • Dilated retinal exam
  • Autoimmunity tests
    • Antinuclear antibody (ANA)
    • Rheumatoid factor (RF)
    • Complement 3 (C3)
    • Complement 4 (C4)
    • ANCA
  • Paraprotein assessment in adults > age 40
    • Serum protein electrophoresis (SPEP)
    • Serum free light chain analysis with immunofixation
    • Urine protein electrophoresis (UPEP)
  • Hepatitis serologies
    • Hepatitis B serology (HBsAg)
    • Hepatitis C serology (antiHCV)

✓ Classify and stage patient based on eGFR and UACR values at 3 months and clinical diagnosis; for example, stage 2 CKD with moderate albuminuria, secondary to hypertension.

CKD Classification and Staging

Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1-150.

✓ Develop patient treatment plan according to level of severity/risk. Key components to prevent and slow disease progression:

  • Control blood pressure with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).
  • Decrease albuminuria.
  • Manage diabetes.
  • Avoid acute kidney injury (AKI).

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