What is the diagnosis for a patient with GFR 45 and creatinine 1.45?

From the Guidelines

The patient has Stage 3a Chronic Kidney Disease (CKD) with a glomerular filtration rate (GFR) of 45 ml/min/1.73m² and an elevated serum creatinine of 1.45 mg/dL, indicating moderate kidney damage and moderately decreased kidney function. This diagnosis is based on the most recent and highest quality study, which recommends a classification framework for CKD that includes GFR categories, cause, and albuminuria categories 1. With a GFR between 45 and 60 ml/min/1.73m², the patient falls into the 3a category, which has distinct differences in outcomes and risk compared to the 3b category with GFR values between 30 and 45 ml/min/1.73m².

Key aspects of managing this patient include:

• Regular monitoring of kidney function every 6 months, including comprehensive metabolic panels to monitor electrolytes, particularly potassium and phosphorus levels.
• Blood pressure control with a target of <130/80 mmHg, as recommended for patients with CKD to prevent progression and reduce cardiovascular risk.
• Medication adjustment, such as avoiding or using NSAIDs with caution and adjusting certain antibiotics and other drugs cleared by the kidneys.
• Lifestyle modifications, including moderate protein intake (0.8 g/kg/day), sodium restriction (<2300 mg/day), and management of comorbidities like diabetes and hypertension.

The importance of albuminuria as a key dimension in risk assessment is highlighted in the KDIGO 2012 CKD guideline 1, emphasizing the need for a comprehensive approach to CKD management that goes beyond GFR categories alone. While earlier guidelines also emphasized the definition and classification of CKD stages 1, the most recent recommendations prioritize a more nuanced understanding of kidney disease, incorporating cause and albuminuria categories to guide treatment and management decisions.

From the Research

Assessment of Patient with GFR 45 and Creatinine 1.45

• The patient's GFR of 45 and creatinine level of 1.45 indicate impaired renal function 2.
• According to the study by 3, a rise in serum creatinine level after initiation of ACE inhibitor therapy is associated with slowing of the renal disease progression in the long run.
• The patient's serum creatinine level of 1.45 is above the normal range, indicating renal insufficiency 3.
• The study by 4 suggests that serum creatinine is not an adequate estimate of glomerular filtration rate (GFR), and more accurate measures of renal function should be used.
• The patient's age and muscle mass may also affect the serum creatinine level, as noted in the study by 2, which found that serum creatinine is a poor screening test for renal failure in elderly patients.
• Other factors, such as the use of creatine supplements, may also influence serum creatinine levels and estimated GFR, as reported in the study by 5.
• In patients with nephrotic syndrome, serum creatinine is a poor marker of GFR, as found in the study by 6.

Possible Diagnoses

• Chronic renal insufficiency 3
• Renal failure 2
• Nephrotic syndrome 6

Further Evaluation

• More accurate measures of renal function, such as the Modification of Diet in Renal Disease (MDRD) formula, should be used to estimate GFR 5.
• The patient's medical history, including the use of creatine supplements, should be carefully evaluated 5.
• Further diagnostic testing, such as inulin clearance, may be necessary to accurately assess renal function 6.