Chronic Kidney Disease Pathway Document Description Presented ...

Identification of CKD in Patients who are not in a High Risk Group
There are few specific signs or symptoms which would alert suspicion to the
possibility of CKD in groups who are not routinely tested due to the presence of
morbidities which would put them at high risk. As a result these patients often
present at a late stage. Another reason for this would be the lack of
understanding of clinical staff on the significance of kidney function testing when
relying only on measurements of serum creatinine concentration. It is therefore
recommended that eGFR be requested as this gives a more accurate picture of
decline in kidney function than rising serum creatinine alone. Currently at Dudley
Group of Hospitals any request for urea and electrolytes (U+E) will automatically
have eGFR calculated and will accompany the results.
Any patient with an eGFR of < 60 mls/min should be investigated following
the renal pathway.
An eGFR of > 60 without other evidence of renal disease should not be
considered significant and these patients should not be subject to further
investigation. However, a diagnosis of Acute Renal Failure should be considered.
In many cases the possibility of renal impairment only comes to light when a
patient receives routine monitoring at a well person clinic, insurance medicals or
during routine investigations for acute illness or any assessment which involves
the monitoring of serum creatinine and/or U+E and/or urinalysis. It is worth
remembering that the majority of these patients will feel well and therefore the
diagnosis of renal impairment will be unexpected, especially if it comes to light as
part of a routine assessment.
Joint Speciality Committee - Royal College of Physicians, The Renal Association
(2006) Chronic Kidney Disease in Adults, UK Guidelines for Identification,
Management and Referral.
http://www.renal.org/CKDguide/full/CKDprintedfullguide.pdf
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