From the Guidelines
To work up kidney disease, start with a comprehensive assessment including medical history, physical examination, and laboratory tests, as recommended by the most recent guidelines 1.
Initial Evaluation
Order a complete blood count, comprehensive metabolic panel (focusing on blood urea nitrogen, creatinine, and electrolytes), urinalysis, and urine protein-to-creatinine ratio.
- Calculate the estimated glomerular filtration rate (eGFR) using the CKD-EPI equation to assess kidney function, as suggested by recent studies 1.
- If abnormalities are detected, proceed with renal ultrasound to evaluate kidney size, structure, and potential obstructions.
Additional Testing
Additional tests may include:
- 24-hour urine collection for protein and creatinine clearance
- Serum protein electrophoresis
- Specific autoimmune markers depending on suspected etiology
- For persistent abnormalities or unclear diagnosis, refer to a nephrologist who may recommend a kidney biopsy, as outlined in recent guidelines 1.
Management
Monitor blood pressure closely, aiming for targets below 130/80 mmHg in most kidney disease patients, as recommended by recent studies 1.
- This systematic approach helps identify the underlying cause of kidney dysfunction, whether it's due to diabetes, hypertension, glomerulonephritis, or other conditions, allowing for appropriate management to slow disease progression and prevent complications.
- Recent studies emphasize the importance of early identification and intervention in chronic kidney disease, as well as the need for accurate diagnosis and staging of CKD to utilize treatments effectively 1.
From the Research
Approach to Diagnosing Renal Disease
The approach to diagnosing and evaluating renal (kidney) disease involves several key steps, including:
- Screening for patients with risk factors, such as diabetes, hypertension, and a history of cardiovascular disease 2, 3, 4, 5
- Using serum creatinine, urine albumin-to-creatinine ratio, and urinalysis to detect and evaluate chronic kidney disease (CKD) 2, 3, 4, 5
- Classifying CKD using the C-G-A classification system, which incorporates glomerular filtration rate (GFR) and albuminuria 3, 5
- Staging CKD to guide treatment, monitoring, and referral strategies 2, 3, 5
Evaluation and Referral
Evaluation and referral of patients with CKD involve:
- Assessing vascular complications and intervening to improve glycemic control and lipid levels 4
- Using medications such as renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide 1 receptor agonists to slow CKD progression 3, 4
- Referring patients to a nephrologist if they have an estimated GFR less than 30 mL per minute per 1.73 m2, persistent urine albumin-to-creatinine ratio greater than 300 mg per g, or evidence of rapid loss of kidney function 2, 6, 5
- Implementing a multidisciplinary approach to care, including primary care physicians, nephrologists, and other subspecialists 6, 5
Importance of Early Diagnosis and Referral
Early diagnosis and referral are critical in managing CKD, as they enable: