Chronic Kidney Disease Pathway Document Description Presented ...

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Diabetes All people with diabetes should receive annual assessment of microalbumin and albumin/creatinine ratio. If raised ACR : • ACR >2.5mg/mmol (male) • ACR >3.5mg/mmol (female) or • Microalbumin level > 30 mg/day Repeat test at next two clinic visits over 3–4 months Microalbuminuria is confirmed if at least one out of two or more results is also raised. http://www.nice.org.uk/nicemedia/pdf/CG66T2DQRG.pdf Microalbuminuria with eGFR >60ml/min/1.73m 2 is stage 1 / 2 CKD. In patients with diabetes (type 1 or type 2), microalbuminuria/proteinuria is an indication for: • Treatment with ACE inhibitors (or Angiotensin receptor blockers if those are not tolerated), with titration up to maximum dose or maximum tolerated dose irrespective of initial blood pressure • Control of hypertension to target • Tight glycaemic control • Monitoring of ACR, serum creatinine and eGFR. • Consider referral to / discussion with the diabetic team or joint diabetic/nephrology clinic for review • Consider referral to Nephrologist. See referral criteria Blood Microscopic haematuria without proteinuria, eGFR >60ml/min • Age >50, refer to Urology • Age 50 with negative urological investigations, treat as CKD stage Microscopic haematuria with proteinuria eGFR >60ml/min • Refer nephrology 42
Lower levels of proteinuria should be monitored annually and patients managed according to CKD stage. Macroscopic haematuria (Use reagent strips and not microscopy) • Fast track Urology referral • If deteriorating function (eGFR), urgent nephrology referral; urgent imaging to exclude obstruction • If GFR
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 and 16: Acute Renal Failure Acute Renal Fai
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: Recommendation: Therefore consider
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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