{"id":325,"date":"2017-03-26T12:45:08","date_gmt":"2017-03-26T12:45:08","guid":{"rendered":"http:\/\/papergp.com\/index.php\/gi-and-renal\/ckd\/"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"ckd","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/others\/renal-and-urology\/ckd\/","title":{"rendered":"CKD"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Rule out causes of acute deterioration<\/strong><\/h4>\n<ul>\n<li>Obstruction<\/li>\n<li>Nephrotoxics<\/li>\n<li>Infection<\/li>\n<li>BP<\/li>\n<li>Diabetes<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>Red flags &#8211; weight loss<\/li>\n<li>Others\n<ul>\n<li>tired, ankle swelling, SOB, itching, frequency, nocturia, medication changes<\/li>\n<\/ul>\n<\/li>\n<li>Examine\n<ul>\n<li>BP, weight, oedema, abdominal examination<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods\n<ul>\n<li>FBC, U+Es, LFTs, calcium, phosphate, HbA1c, lipids<\/li>\n<li>CKD 4 or 5 &#8211; bicarbonate, Vitamin D, PTH<\/li>\n<\/ul>\n<\/li>\n<li>Urine &#8211; dip, MSU, ACR<\/li>\n<li>USS KUB\n<ul>\n<li>see below<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Explanation\n<ul>\n<li>kidneys have several functions 1) filter blood, 2) maintain BP 3) help with red blood cell production. Over time, kidneys become less efficient, this is made worse by diabetes and high BP.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Lifestyle &#8211; weight loss, exercise, stop smoking, reduce salt intake<\/li>\n<li>Avoid nephrotoxic drugs<\/li>\n<li>BP control<\/li>\n<li>Vaccinations &#8211; annual flu, one off pneumococal<\/li>\n<li>Statins<\/li>\n<li>Aspirin &#8211; if QRISK &gt; 20%<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Follow-up \/ Safety-net\n<ul>\n<li>Annual blood tests, urine ACR, BP monitoring<\/li>\n<li>Refer\n<ul>\n<li>stage 4 onwards<\/li>\n<li>stage 3 with fall of eGFR &gt;5ml\/year<\/li>\n<li>persistent proteinuria<\/li>\n<li>macroscopic haematuria (if negative urological evaluation)<\/li>\n<li>uncontrolled hypertension<\/li>\n<li>Hb &lt; 11 (after exclusion of other causes)<\/li>\n<li>persistently abnormal potassium, calcium or phosphate<\/li>\n<li>red flags (rapidly declining eGFR, hyperkalaemia, malignant hypertension, renal artery stenosis)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<p><strong>Urine ACR<\/strong><\/p>\n<ul>\n<li>ACR &gt; 3.5 &#8211; microalbuminuria<\/li>\n<li>ACR 30 &#8211; consider ACE-I\/ARB<\/li>\n<li>ACR 70 &#8211; consider ACE-I\/ARB + referral<\/li>\n<li>ACR &gt; 250 &#8211; nephrotic range, consider urgent referral<\/li>\n<\/ul>\n<p>nb: consider repeating and ensure first morning sample<\/p>\n<p>nb: lower ranges if diabetic &#8211; see data intepretation <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/urine-acr-albumincreatinine-ratio\/\">ACR<\/a><\/p>\n<p><strong>USS KUB indications<\/strong><\/p>\n<ul>\n<li>progressive CKD (eGFR falls &gt; 5 within 1 year or &gt;10 within 5 years)<\/li>\n<li>visible haematuria or persistent microscopic haematuria<\/li>\n<li>urinary sepsis<\/li>\n<li>FH of polycystic kidney disease<\/li>\n<li>Stage 4 or 5 CKD<\/li>\n<\/ul>\n<p><strong>Vitamin D and calcium<\/strong><\/p>\n<ul>\n<li>Mineral metabolism is disturbed in most patients with CKD 4 onwards<\/li>\n<li>If Vitamin D &lt; 75 nmol\/L &#8211; consider Adcal 2 tabs daily<\/li>\n<\/ul>\n<p><strong>BP targets<\/strong><\/p>\n<ul>\n<li>&lt; 140\/90 &#8211; non diabetic<\/li>\n<li>&lt;13\/80 &#8211; diabetic<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rule out causes of acute deterioration Obstruction Nephrotoxics Infection BP Diabetes &nbsp; Data gathering Red flags &#8211; weight loss Others tired, ankle swelling, SOB, itching, frequency, nocturia, medication changes Examine BP, weight, oedema, abdominal examination &nbsp; Clinical management Investigations Bloods FBC, U+Es, LFTs, calcium, phosphate, HbA1c, lipids CKD 4 or 5 &#8211; bicarbonate, Vitamin D, &hellip; <a href=\"https:\/\/papergp.com\/index.php\/others\/renal-and-urology\/ckd\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">CKD<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2306,"menu_order":189,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-325","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=325"}],"version-history":[{"count":8,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/325\/revisions"}],"predecessor-version":[{"id":2186,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/325\/revisions\/2186"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2306"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}