Chronic Kidney Disease Pathway Document Description Presented ...

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Management of a Previously Undiagnosed Patient with eGFR < 60mls/min Is the YES patient acutely unwell NO YES Manage illness as appropriate. Repeat eGFR within 1-5 days (Go to *) Symptoms of outflow obstruction** YES Palpate for bladder Urgent renal ultrasound (Renal ultrasound scan if history suggestive of urological disease) NO * Has a reduced eGFR (< 60mls/min) or raised creatinine been measured previously NO Repeat eGFR within 5 days Suspect ARF in the presence of any of the following: eGFR < 30 ml/min eGFR fall of 25% Creatinine rise of 50% Blood and Protein in urine YES Check previous eGFR results. Calculate eGFR using the 4- variable MDRD formula from previous creatinine results. Compare results and track rate of progression chronologically. Suspect ARF if there is: • A fall in eGFR of 25% • A rise in Creatinine of 50% • eGFR < 30 ml/min • Blood and Protein in urine URGENT ADMISSION Refer to/ Discuss with nephrologist. Contact details **People with CKD and renal outflow obstruction should normally be referred to urological services, unless urgent medical intervention is required. 16
Next Steps Any patient suspected to have ARF should be admitted urgently to nephrology services/emergency department with as much information as possible, including all previous results available for: • Creatinine • eGFR • Blood pressure • Urinalysis • HbA1C (if diabetic) To include a list of current medication (including OTC) and any relevant medical history. Further information upon which to make a clinical decision should be sought urgently by contacting the nephrology department. Contact details: On call renal consultant: (Advice/Urgent admission) 01384 244432 (direct line) (or 01384 456111 to switchboard at RHH and ask for on-call renal consultant) Fax./urgent paper referral 01384 244543 Haemodialysis 01384 244384 (Nursing Station Renal Unit) CAPD 01384 244388 (Nursing Station Renal Unit) Return to overview Diagnosis of CKD 17
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 and 14: Joint Speciality Committee - Royal
Page 15: Acute Renal Failure Acute Renal Fai
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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