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CKD update

CKD update . Dr Saqib Mahmud MRCP(UK),MRCGP. Chronic kidney disease. Defined by a reduced eGFR, proteinuria, haematuria and/ or structural abnormalities persistent for more than 90 days. Introduction. Prevalence – over 13% of population; rising as a consequence of DM & Obesity

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CKD update

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  1. CKD update Dr Saqib Mahmud MRCP(UK),MRCGP

  2. Chronic kidney disease Defined by a reduced eGFR, proteinuria, haematuria and/ or structural abnormalities persistent for more than 90 days

  3. Introduction • Prevalence – over 13% of population; rising as a consequence of DM & Obesity • Primarily a marker of CV risk • Stage 3 CKD – 40 – 100% increased risk of CV events • Minority at risk of progressive decline in renal function

  4. Classification • Stage 1 : GFR>90 (presence of kidney damage with N or raised GFR) • Stage 2 : GFR 60 – 89 (presence of kidney damage with mildly reduced GFR) • Stage 3A : GFR 45 – 59 • Stage 3B : GFR 30 – 44 , moderately reduced GFR • Stage 4 : GFR 15 – 29 , severely reduced GFR • Stage 5 : GFR <15 , end-stage RF

  5. Basic investigations • Repeat U&E, eGFR (within 3/12) • FBS • FBC • Dipstick urine for haematuria • Urine ACR or TPCR • Ca, PO4

  6. Further investigations • Hypercalcaemia – inv for myeloma • LUTS, deteriorating renal function – renal tract USS • Significant proteinuria +/- haematuria –> primary glomerular disease or vasculitis– autoimmune screen/refer

  7. Management • Main aims ; slow deterioration of renal function – tight control of BP • Reduce CV risks • Maintain SBP at 129-139, DBP below 80 • SBP below 100 – 110 may be detrimental • ACEI / ARB confer additional benefit, slow decline of renal function & proteinuria

  8. Monitoring • U&E post ACEI mandatory • Stable CKD3A & B – U&Es 6/12, CKD4 -3/12 • d/c ACEI if SCr rises >30%, eGFR falls>15% baseline • Thiazide diuretics lose their efficacy in Rx of HTN in CKD as GFR decline – loop diuretics Rx of choice

  9. Drug administration • Certain drugs CI, require dose adjustment • d/c metformin if eGFR <30 • Insulin dose may need to be reduced

  10. Referral • Most CKD patients managed in primary care • Consider referral; younger patients with CKD any stage • Deteriorating renal function • Significant protienuria >1g/d or proteinuria + haematuria>1+ • Poorly controlled HTN despite 4 drugs • Renal anaemia

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