Practice Guideline - Kidney Disease - Early
Detection and Treatment
The United States has 19 million people with chronic kidney disease. Poor
outcomes such as kidney failure, cardiovascular disease and premature death
can be prevented or delayed. The National Kidney Foundation recommends that
all people at increased risk for kidney disease be tested for markers of
kidney damage. MCI endorses the following recommendations:
- Risk factors for
kidney disease
include:
| Diabetes |
Autoimmune
diseases |
| Hypertension |
Age >
65* |
| Urinary
Tract
Infections |
Ethnic
minority
status* |
| Drug
Exposure
(NSAID, etc) |
Positive
Family
History* |
| Urinary
Stones |
*not a
Medicare
billable
diagnosis |
- Evaluate
patients at risk for
kidney disease
yearly for
albuminuria.
Testing can be done
with a spot urine,
using albumin
specific dipsticks.
-
Confirm a
positive dipstick
test (Microalbumin/Creatinine
> 30 or Micral
>20) with a
quantitative
measurement by
sending a spot urine
to MCL.
-
Evaluate patients
with confirmed
kidney disease to
determine:
- Diagnosis
(diabetes,
vascular,
glomerular,
interstitial,
cystic)
- Co-morbid
conditions
(cardiovascular,
anemia, etc.)
- Severity by
assessing GFR
(normal is
greater than 90)
-
|
GFR = |
(140-age) x weight in Kilograms |
X 0.85 in females |
|
|
72 x serum creatinine in mg/dl |
|
-
Treatment
of chronic kidney
disease includes:
- Control of
blood pressure to
less than 130/85
- Use of
ACEI or ARB
medications
- Control of
lipids to LDL < 100
- Avoidance
of excessive protein
intake (1.2 gm / Kg
/ day)
- Cessation
of tobacco use
- Referral
for progression of
disease
References:
- “Nondiabetic
kidney disease”
NEJM, Nov. 7, 2002
- “National Kidney
Foundation Chronic
Kidney Disease
Guideline” on line
at:
http://www.kidney.org/professionals/doqi/kdoqi/toc.htm
Variation from
this guideline is always
acceptable if in the
opinion of the attending
physician individual
circumstances require
it.
|
