Sudden or severe onset of symptoms (e.g.Constitutional symptoms suggesting systemic illness.volume contraction, febrile illness, medications). Rapid sustained decline in kidney function (change in eGFR > 10-15%/year) despite remedy of reversible.glomerulonephritis) must be considered in patients with: Even if the cause seems obvious (e.g., diabetes), the possibility of a serious underlying primary renal disorder (e.g. The two most common causes of CKD are hypertension and diabetes and they often co-exist 13. polycystic kidneys on ultrasound histological findings on kidney biopsy. Refer to page 3 for more information.įor diagnostic purposes, other evidence of kidney damage includes: urine abnormalities such as hematuria structural problems on imaging studies e.g. Note: the recommended equations for eGFR may change over time and are estimates only. All labs in British Columbia (BC) automatically report eGFR when creatinine is ordered. eGFR is the best marker for kidney function and is calculated from creatinine. The two key parameters for classification are estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (uACR). CKD prevalence by health service delivery area, 2016/2017.ĬKD is defined as an abnormality of kidney structure or function that is present for greater than 3 months 13. This underscores the importance of early detection, evaluation and management of individuals with kidney disease.įigure 2. The outcome of many patients who go on to dialysis remains poor with 10 percent annual mortality the overall 5 year survival rate is worse than that of most cancers 3.Įvidence clearly indicates that control of hypertension and proteinuria can prevent or postpone kidney function decline 4–12. Most patients with chronic kidney disease die from other comorbidities before they progress to kidney failure. Patients with CKD have a risk of progression to end stage renal disease (ESRD), often requiring dialysis or kidney transplantation 6, 9, 11-14. 2013 3:1–150ĬKD is associated with other common chronic diseases such as diabetes, hypertension, and cardiovascular disease (CVD) 1 and an estimated 1:10 British Columbians has some form of significant kidney disease 2.ĬKD markedly increases the risk of: cardiovascular disease, adverse drug reactions, acute kidney injury and prolonged hospital admissions 4-10, 13-14. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
* Adapted from ckdpathway.ca and Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Prognosis and recommendations for frequency of monitoring based on eGFR and uAC * Prompt advice from local internists, local nephrologists or the RACE Line is available to assist in determining the need for and timing of referralįigure 1.The three dimensions of Cause, e GFR and Albuminuria (CGA) are all important in developing a management plan.The cause of CKD has important implications for the risk of end stage renal disease (ESRD) and other complications Determine likely cause of kidney disease where possible.Confirm abnormal test results with a repeat measurement and obtain urinalysis Screen high-risk patients using eGFR and uACR.Identify high-risk patient groups for evaluation of CKD: diabetes, hypertension, cardiovascular disease, family history, high risk ethnicity (Indigenous peoples, Pacific Islanders, African, Asian, and South Asian descent), history of acute kidney injury (AKI).
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