Diagnosing Kidney Disease

GFR numbers are the single most important factor in determining a patient’s CKD treatment

Chronic kidney disease (CKD) is rarely reversible, but with treatment it can be slowed and the need for dialysis and transplantation postponed. CKD severity is divided into five stages based on the glomerular filtration rate (GFR).

Early diagnosis of kidney disease is the key to managing patient health. Kidney disease often goes undetected until the kidneys are at failure and require dialysis or transplantation. Understanding the risk factors and the symptoms of CKD enable early detection and effective disease management. When primary care physicians work closely with our nephrologists, we are able to slow the progression of the disease and keep out patients healthier longer.

Kidney Disease Risk Factors


Many things play a role in determining risk for kidney disease including lifestyle, genetics and race. Risk factors include:

  • Diabetes
  • High blood pressure
  • Family history
  • Being African-American 
  • Age

Symptoms of Kidney Disease

  • Changes in urination
  • Swelling in legs, ankles, feet, hands
  • Fatigue
  • Itching
  • Food doesn’t taste right
  • Nausea, vomiting
  • Shortness of breath
  • Feeling cold
  • Dizziness, trouble concentrating

Key

ACE or ARB – angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers used to treat high blood pressure
BP – Blood pressure
DM – Diabetes Mellitus
ESRD – End stage renal disease
GFR – Glomerular filtration rate
Q – Frequency of test
UA – Urinalysis
CA, P, PTH – Calcium, Phosphorous, parathyroid hormone
 

Stage

GFR

Description

Goals

 Testing

Treatment

1

>90

At risk for kidney disease

•    Slow progression through education

•    Treat co-morbid conditions

•   BP monitoring

•   UA, lipids, renal panel w/ GFR Q6mo

•   BP goal< 125/75 if proteinuria, otherwise 130/80

•   DM, lipid control

•       ACE or ARB if DM or proteinuria

2

60-89

Mild decrease in kidney function

•    Slow progression through education

•    Treat co-morbid conditions

•   BP monitoring

•   UA, lipids, CBC, iron & renal panels w/ GFR Q4mo

•   Kidney US

•    BP, DM and lipid control

•    ACE or ARB

•    Correct anemia

•    Initial Nephrology consult

•    Initial nutritional therapy, CKD education

3

30-59

Moderate decrease in kidney function

•    Slow progression through education

•    Treat co-morbid conditions

•   BP monitoring

•   H&H, iron & renal panels w/ GFR Q3 mo

•   CA, P, PTH Q6mo

•    BP, DM and lipid control

•    ACE or ARB

•    Renal vitamins

•    Correct anemia/iron deficiency

•    Treat renal osteodystrophy

•    CKD education

•    Nephrology care

4

15-29

Severe decrease in kidney function

•    Slow progression through education

•    Treat co-morbid conditions

•    Prepare for end stage renal failure care

•   BP monitoring

•   H&H, iron & renal panels w/ GFR Q3 mo

•   CA, P, PTH Q6mo

•    BP, DM and lipid control

•    ACE or ARB

•    Renal vitamins

•    Correct anemia/iron deficiency

•    Treat renal osteodystrophy

•    CKD education

•    Nephrology care

•    Kidney transplant evaluation

•    Vascular access consultation

5

<15

Kidney failure

 Begin renal replacement therapy

 ESRD protocols

 Renal replacement therapy

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