Chronic Kidney Disease

Screening

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1. The evidence supports screening of high risk patients which includes (in Australia) the following:
◦Age > 50 yrs
◦Hypertension
◦Smoking
◦Obesity
◦FH renal disease
◦Diabetes
◦obstructive problems
◦ATSI

2. Screening recommended:
◦BP
◦eGFR
◦urine for protein / albumin
◦spot early morning ACR for preference if albumin dipsticks not available (UK)
◦could get by on urine dipstick for protein if not diabetic (Aus guidelines)
◦if positive then quantify with spot urine PCR
◦a dipstick would detect blood as well (sensitive)

3. any abnormal tests need to be repeated twice to confirm

4. proteinuria
◦persistent proteinuria or albuminuria are the strongest independent predictors of progression to end stage kidney disease
◦strongest predictor of CVS risk
◦early intervention to reduce proteinuria reduces adverse outcomes by 50%
◦the worse the proteinuria the greater the benefit

5. Treating proteinuria
◦Reducing BP to target level is the single most important measure
◦ACE and/or ARBs are the preferred drugs
◦Treatment response can be monitored by quantifying proteinuria (for each 50% reduction the risk of end stage renal disease, CVS and CCF are reduced by 45%, 18% and 27% respectively
◦Diuretics may synergistically enhance the effects of ACEs or ARBs
◦Intensive glycaemic control may help
◦Statins produce a modest reduction in proteinuria (and small decrease in rate of kidney function loss)