Detecting kidney disease

Kidney Health Australia provide an algorithm in Chronic Kidney Disease (CKD) Management in General Practice (2nd edition) to assist GPs to detect chronic kidney disease, and guide decisions about when to refer to a nephrologist for further investigation.1 The algorithm is linked to Clinical Action Plans which cover management goals and strategies, guidance for clinical assessment (including cardiovascular risk) and laboratory monitoring.

Kidney Health Australia algorithm — a case example

Below is a possible pathway using the Kidney Health Australia algorithm for kidney disease detection in a 69-year-old male with diabetes and controlled blood pressure. The algorithm begins with Kidney Check tests for glomerular filration rate (eGFR) and albuminuria (urine albumin:creatinine ratio).1


eGFR (mL/min/1.73 m2)
Albumin:creatinine ratio  (mg/mmol)
Day 1
50 19
Repeat test required?
Yes, as eGFR < 60 mL/min/1.73 m2, repeat eGFR is required within 14 days
Yes, as albumin:creatinine ratio was ≥2.5 mg/mmol, repeat urine albumin:creatinine ratio is required two times in the next 3 months (preferably first morning void)
Day 12
49
19
Repeat test required?
As there is a stable reduced eGFR, repeat eGFR within 3 months
Yes, see above
Day 70
49
20

Check eGFR after 3 months
Check albumin:creatinine ratio after 3 months
Day 100
49
19

Criteria met for chronic kidney disease

  • Reduced kidney function: minimum 3 reduced eGFRs, present for ≥ 3 months
  • Kidney damage: minimum 2 out of 3 elevated urine ACR’s, present for ≥ 3 months

The patient described above has kidney function Stage 3a (eGFR 45–59 mL/min/1.73 m2) with microalbuminuria (albumin:creatinine ratio 2.5–25 mg/mmol), secondary to diabetic kidney disease.1

Referral to a renal service or nephrologist is not recommended as this patient has:

  • Stable eGFR ≥ 30 mL/min/1.73 m2
  • Urine albumin:creatinine ratio < 30 mg/mmol (with no haematuria)
  • Controlled blood pressure

Note: The decision to refer or not must always be individualised and the indications for referral may be less stringent particularly in younger people.

References
  1. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. 2nd edition. 2012. http://www.kidney.org.au//LinkClick.aspx?fileticket=vfDcA4sEUMs%3d&tabid=635&mid=1584 (accessed 30 May 2013).