Chronic Kidney Disease Pathway Document Description Presented ...

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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 Return to overview 14
Acute Renal Failure Acute Renal Failure (ARF) is a medical emergency as deterioration can be rapid and fatal in many cases. Prognosis for recovery of kidney function is dependent on the time delay between presentation and diagnosis. It is therefore extremely important that people with suspected ARF are identified and investigated promptly to ensure best possible outcomes. These patients should receive prompt admission to acute nephrology services/emergency department. ARF is characterised by rapid deterioration in renal function over a period of hours or days. It should be suspected in the presence of an acute illness with the following signs/symptoms: • A 50% rise in serum creatinine concentration • A 25% fall in eGFR (if baseline unknown, assume 75mls/min) N.B. eGFR should be interpreted with caution as it should be calculated in stable creatinine concentrations • Oliguria (urinary output
Page 1 and 2: Chronic Kidney Disease Pathway Docu
Page 3 and 4: Pathway for the Identification and
Page 5 and 6: Contents Introduction …………
Page 7 and 8: Introduction Chronic kidney disease
Page 9 and 10: CKD Pathway D I A G N O S I S Ensur
Page 11 and 12: Kidney function deteriorates natura
Page 13: Joint Speciality Committee - Royal
Page 17 and 18: Next Steps Any patient suspected to
Page 19 and 20: Return to overview CKD Stages CKD S
Page 21 and 22: Practice Action Plan Compiling a Ch
Page 23 and 24: Action Rationale Responsible Run a
Page 25 and 26: eGFR
Page 27 and 28: CKD Stages CKD Stage Description Re
Page 29 and 30: References Joint Speciality Committ
Page 31 and 32: Cardiovascular Risk All patients wi
Page 33 and 34: Hypertension Blood pressure should
Page 35 and 36: Further information on the pharmaco
Page 37 and 38: Irbesartan* Valsartan Losartan* *Sp
Page 39 and 40: • Diuretics • Lithium carbonate
Page 41 and 42: Recommendation: Therefore consider
Page 43 and 44: Lower levels of proteinuria should
Page 45 and 46: Glycaemic Control CKD and Diabetes
Page 47 and 48: References Audit Commission (2002)
Page 49 and 50: Influenza and Pneumococcal Vaccine
Page 51 and 52: Stage 3 Management at stage 3 shoul
Page 53 and 54: If all other causes for the anaemia
Page 55 and 56: Clinic inclusion criteria: Patients
Page 57 and 58: Where vitamin D supplementation is
Page 59 and 60: Stage 5 Patients identified at CKD
Page 61 and 62: Information to include with referra
Page 63 and 64: Appendix 1 The Dudley Group of Hosp

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