| Chronic Kidney Disease (CKD) is a major
health problem in South Africa and is associated with
significant morbidity, mortality and high medical
expenditures. Early detection and optimal management can
prevent premature death, and prevent or delay the need
for dialysis / transplantation. CKD may be present in
more than 10% of the adult population, particularly in
high risk groups. Definition
Glomerular Filtration rate (GFR) < 60 ml/min or markers
of kidney disease present for more than 3 months.
Such markers include:
· Proteinuria
· Haematuria
· Abnormal renal imaging e.g. Sonar
NB: Serum creatinine alone may not accurately
reflect kidney function, and therefore, the GFR should
be estimated from the serum creatinine using prediction
equations. For example, this modified COCKROFT-GAULT
formula:
SCHWARTZ formula for children:
Risk factors for CKD
· Diabetes Mellitus
· Hypertension/CVS disease
· Age>50 years
· Family history of kidney disease
· HIV and AIDS
In children these risk factors include:
· Glomerulonephritis
· UTIs
· Congenital abnormalities
· Kidney stones
How to Screen for CKD
· Urine dipstix and blood pressure measurement at least on annual
basis
· In diabetics, perform a microalbumin dipstix or have a spot
urine albumin:creatinine ratio
(ACR) at least annually
· Patients with detected abnormalities should have a serum
creatinine test performed, urine
protein:creatinine ratio and a creatinine clearance
calculated as suggested above
Consider referring the following patients for an
opinion
· Proteinuria or persistent haematuria
· GFR<60ml/min or creatinine >150µmo/l
(lower in children)
· Familial kidney disease e.g. Polycystic
kidney disease
· All children with renal problems should
be referred immediately
Why investigate or refer patients with kidney
disease?
· Establish a specific diagnosis and treat
reversible diseases
· Identify co-morbid conditions, prevent
and manage further complications of CKD
· Optimise management to slow progression
of CKD; most effective when instituted early in
the disease
· Plan renal replacement therapy well
before end-stage kidney disease is reached
Recommendations to preserve renal function in
patients with CKD
· Lifestyle modification
- Weight loss
- Aerobic exercise
- Smoking cessation
· Blood pressure control
- Blood
pressure target < 130/80 mm Hg
- ACE inhibitors and ARBs are the first
line antihypertensive agents
-Combination therapy often Required to
achieve targets
· In Diabetics
- BP control is paramount
- Optimal glycemic control HbA1c< 7%
· Proteinuria
- Reduce Proteinuria using ACE inhibitors
and /or ARBs target < 1g/day
· Nephrotoxic drugs
- Avoid NSAIDS and COXIBS, Aminoglycoside
antibiotics and contrast agents
· Calcium and Phosphate
- Maintain normal calcium and Phosphate
levels, monitor PTH levels, especially in children
· Anaemia
- Develops early in CKD and requires
therapy to maintain an Hb of 11-12 g/dl
LANCET LABORATORIES Pretoria:
Switchboard: (012) 483 0100
Client services: (012) 483 0110
LANCET LABORATORIES Johannesburg:
Switchboard: (011) 358 0800
Client services: (011) 358 0888
LANCET LABORATORIES Kwa-Zulu Natal:
Switchboard: (031) 308 6500
Client services: (031) 308 6655 |
