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 COCKCROFT-GAULT
formula:
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 dipstick and blood pressure measurement at
least on annual basis
- In diabetics, perform a microalbumin dipstick 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 |
