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Chronic Kidney Disease

Definition

eGFR < 60 mL/min/1.73 m2 that is present for more than 3 months +/- evidence of kidney damage
OR
Evidence of kidney damage for more than 3 months +/- eGFR < 60 mL/min/1.73 m2

Markers of Kidney Damage

  • Albuminuria
  • Urine sediment abnormalities
  • Electrolyte and other abnormalities due to tubular disorders
  • Abnormalities detected by histology
  • Structural abnormalities detected by imaging
  • History of kidney transplantation

Diagnosis of proteinuria

Who to screen for CKD?

  • Age > 65 years old
  • Obesity CV disease
  • Metabolic syndrome (pt with DM &/or HTN should be screened at least yearly)
  • Drugs e.g. nephrotoxic drugs, long-term use of PPI or analgesics (e.g. NSAIDs, COX-2 inhibitors)
  • Family h/o CKD or hereditary disease
  • Gout
  • Multisystem diseases with potential kidney involvement e.g. SLE
  • Structural renal disease, renal calculi or prostatic hypertrophy
  • Incidental detection of hematuria or proteinuria

Screening algorithm

Without diabetes
With diabetes

Approach to haematuria

  • A positive dipstick test for blood on 2 out of 3 occasions warrant a full microscopic examination.
  • Urine microscopy can be used to differentiate hematuria of glomerular or non-glomerular origin.
  • Some common causes of persistent microscopic hematuria: infection, glomerulonephritis, renal calculi, malignancy & other forms of kidney damage
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