Diagnosis and Progression of CKD

In 2002 the National Kidney Foundation Kidney Disease Outcomes Initiative came up with a set of guidelines for diagnosis and treatment of CKD.  Those guidelines have since been revised, and an update set of guidelines was published in 2012.  This post reflects the information presented on the updated guidelines. 

The National Kidney Foundation defines CKD as the “…abnormalities of kidney structure or function, present for >3 months, with implications for health.” 

So, how does one know if they have CKD?  By measuring the glomerular filtration rate (GFR).  The GFR is a number that shows how well the kidneys are filtering out the bad stuff and holding onto the good stuff. 

How do we measure GFR?  By taking a sample of a person's blood and sending it the lab.  The lab has a special equation they use to calculate the estimated GFR.  This number will show how damaged the kidneys are. 

A picture of the GFR numbers that go along with kidney health 

Image source  http://www.safekidneycare.org/patient_family_gfr_calc.php    

The other number the healthcare team will look at is the presence of albuminuria.  Albuminuria means there is too much protein the urine.  It is measured by taking a urine sample in the morning.

Ms. Kidney getting her urine checked for albuminuria 

Image source  Albuminuria: http://thinkkimi.com/Research/index.html

Not everyone should be tested for CKD.  The US Preventive Services Task Force does not believe there is enough evidence to screen people who do not have risk factors. 

People who should be screened for CKD include people with diabetes, hypertension, autoimmune disease (i.e. Lupus), systemic infections, UTIs, urinary stones, lower urinary tract obstruction, neoplasia, family history of CKD, recovery from acute renal failure, exposure to certain drugs, and/or low birth weight. 

It is also recommended that African American, American Indian, Hispanic, Asian or Pacific Islander, adults over 65, and/or people who have been exposure to certain chemicals and environmental conditions be tested as well. 

If you have been diagnosed with CKD it is recommended that you have your GFR and albuminuria measured at least once a year, and more often if you have certain risk factors.  Your doctor will likely have you begin taking drugs to control your blood pressure, as well as ACE inhibitors, ARBs, or beta-blockers (more on this in a few weeks). 

CKD can lead to:

•         Heart disease
•         Bone disorders like osteoporosis, and scoliosis
•         Anemia
•         Malnutrition

Because of the wide range of problems that can arise with CKD, it is recommended that a multidisciplinary team care for CKD patients.

And now a short video featuring CKD patients talking about their diagnosis...

Reference:

Inker LA, Astor BC, et al. KDOQI US Commentary of the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD.  Am J Kidney Dis.  2014;63(5):713-735. http://dx.doi.org/10.1053/j.ajkd.2014.01.416.