The Oakwood Surgery
Clinical Protocols
Chronic kidney disease
Author
Created
Reviewed
Review Date
Dr Dean Eggitt
October 2012
October 2014 (Dr Eggitt)
October 2015
Background
CKD is chronic kidney disease. It is usually the result of long term insults to the
kidneys from tablets or other diseases. Hypertension and diabetes are common causes
of CKD.
CKD is diagnosed partly by calculating the estimated glomorular filtration rate or
eGFR – this is the indication of the kidney’s ability to do its job as a filter. It is very
variable. CKD is diagnosed when the eGFR is persistently reduced in the presence of
other disease indicators.
CKD is broken down into 5 stages.
Stages
1-2
3
4
5
eGFR
Severity
> 60
30 – 59
15 – 29
<15
Mild
Moderate
Severe
End stage
When kidneys are damaged, they begin to leak blood and protein. This can be
detected in the earliest stages by sending the urine to the laboratory for an albumin
creating ratio urine test (ACR). This test result is only valid when there is no urinary
tract infection, so an ACR urine sample should always be sent with an MSU at the
same time.
A raised ACR in the early stages is called microalbuminuria and is potentially
reversible. It is an independent risk factor for cardiovascular disease so should be
taken seriously because there is a chance to reverse the disease process. At late
stages, the miscroalbuminuria may progress to proteinuria where lots of protein is lost
through the kidneys, this is no longer reversible and the damage is done.
Male
Female
Significant ACR
(diabetic and CKD)
>2.5
>3.5
Significant ACR
(normal patients)
>20
>20
CKD 3
1) Confirm diagnosis
TWO abnormal U&E results 2 weeks apart
eGFR <60 on both occasions
2) At first diagnosis,
a. check FBC, Bone function, Lipids, LFT, FBS
b. Needs first morning urine sample for ACR and MSU
c. Check blood pressure
d. Calculate QRISK2 score – consider statin if indicated
3) Chase results of MSU
a. If >2 cells blood in urine on microscopy– refer GP
4) Chase results of ACR
a. If protein, repeat ACR and MSU to confirm diagnosis.
Microalbuminuria / proteinuria can only be confirmed in the absence
of a UTI.
b. If UTI, treat and retest for ACR.
c. If confirmed microalbuminuria / proteinuria use microalbuminuria /
proteinuria protocol.
5) If BP > 140/85 on 3 separate occasions start ramipril as per hypertension
protocol
6) Code CKD as a major problem
7) Add to annual recall