The primary care professional is essential to early detection and ongoing management of chronic kidney disease and primary interventions can help delay the need for referral to a nephrologist.
There are several professional society guidelines available to guide care, although the recommendations may conflict at times, according to the National Kidney Disease Education Program (NKDEP).
The NKDEP created a concise guide specifically for the busy primary care professional that highlights the most important considerations for diagnosing and slowing the progression of CKD. The slides that follow offer a look at the 2 key laboratory studies used to detect CKD as presented by the NKDEP, and in brief.
Estimated Glomerular Filtration Rate (eGFR) declines as nephrons are damaged or destroyed.
CKD severity as evaluated by eGFR.
Limitation of eGFR as a measure of severity of CKD is that current estimating equations are rouhgly 80-90% being within +/- 30% of measured GFR.
The urine albumin-to-creatinine ratio (UACR) is the preferred measure for screening, assessing, and monitoring renal damage.
There are 3 categories of severity of albuminuria in CKD.
Albuminuria reflects glomerular damage, is an independent risk factor for CKD progression, and is consdiered a marker for CVD/mortality in persons with hypertension.
Urine albumin measurement is not standardized and common assays have demonstrated imprecision. Daily within patient variation may also affect risk assessment.
Initial evaluation after CKD is identified may include a wide range of laboratory studies to help establish etiology and provide baseline data for primary care and a nephrologist, as needed.
Further workup for additional information in a patient with CKD.
Identifying the cause of CKD distinguishes between a systemic or localized renal condition as the functionality of the organ will affect choice of management strategy.