30 hours ago · Identify Patients with CKD. Screen people at risk for CKD, including those with. diabetes mellitus type 1 or type 2. hypertension. cardiovascular disease (CVD) family history of kidney failure. The benefit of CKD screening in the general population is unclear. The two key markers for CKD are urine albumin and eGFR. >> Go To The Portal
CKD is a structural and/or functional abnormality of the kidney that lasts 3 months or longer. It’s a progressive and chronic condition that affects many aspects of the patient’s health. The top three causes of CKD (in order of incidence) are diabetes, hypertension, and glomerulonephritis.
However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies.
Regardless of CKD stage, the three main nursing care goals are: prevent or slow disease progression promote physical and psychosocial well-being monitor disease and treatment complications.
IMPORTANCE Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death. OBSERVATIONS
The blood urea nitrogen (BUN) and serum creatinine levels will be elevated in patients with CKD. Hyperkalemia or low bicarbonate levels may be present. Serum albumin levels may also be measured, as patients may have hypoalbuminemia as a result of urinary protein loss or malnutrition.
Your kidney numbers include 2 tests: ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate). GFR is a measure of kidney function and is performed through a blood test. Your GFR will determine what stage of kidney disease you have – there are 5 stages. Know your stage.
Chronic kidney disease (CKD) can be diagnosed with blood and urine tests. In many cases, CKD is only found when a routine blood or urine test you have for another problem shows that your kidneys may not be working normally.
Kidney function test results can tell you whether your kidneys are functioning typically or not. Most function tests look for two measurements: GFR of less than 60 could indicate kidney disease. Urine albumin-to-creatinine ratio (UACR) of more than 30 milligrams per gram could be a warning sign of kidney disease.
Management of CKD involves an interdisciplinary approach. Monitoring trends in urine albumin-to-creatinine ratios (UACR) and estimated glomerular filtration rates (eGFR) may be used to assess response to interventions. Medical interventions that may help slow progression include control of blood pressure, use of medications that block the renin-angiotensin-aldosterone system (RAAS) to lower urine albumin; and glucose control in those with diabetes. Interventions may include nutrition therapy, lifestyle modification, and self-management education.
Complications include, but are not limited to, cardiovascular disease; anemia; malnutrition; mineral and bone disorders; depression and reduced functional status.
Knowledge of kidney function is important for dosage of medications that are excreted by the kidneys. Food and Drug Administration (FDA)-approved drug-labeling guides provide adjustments of drug dosages for patients with impaired kidney function.
Medical interventions that may help slow progression include control of blood pressure, use of medications that block the renin-angiotensin-aldosterone system (RAAS) to lower urine albumin; and glucose control in those with diabetes. Interventions may include nutrition therapy, lifestyle modification, and self-management education.
Chronic kidney disease is defined as abnormalities of kidney structure or function, present for greater than 3 months, with implications for health. 1 Diagnostic criteria include a decreased glomerular filtration rate (GFR) or presence of 1 or more other markers of kidney damage. 1 Markers of kidney damage include a histologic abnormality, structural abnormality, history of kidney transplantation, abnormal urine sediment, tubular disorder-caused electrolyte abnormality, or an increased urinary albumin level (albuminuria).
Quest Diagnostics offers many tests and panels for diagnosis and management of chronic kidney disease. Test offerings range from health screenings for abnormal eGFR, proteinuria, and/or albuminuria, to tests for management of CKD and its comorbidities and complications. For example, the Diabetes, Advancing Chronic Kidney Disease Management Panel (test code 91713) combines many of these tests according to the recommendations of the American Diabetes Association. 14
The gold standard for measured GFR (mGFR) is the inulin clearance method, but this test is difficult to perform in clinical practice. Clearance measurements using iohexol, 125 I-iothalamate, and several chelated isotopic radiotracers provide alternatives to the inulin reference method for mGFR, but each has limitations. 2 These methods are usually reserved for specific circumstances, such as determining correct drug dosing in therapy that requires the most accurate assessment of kidney function, or when clinical decision-making is affected by having disparate results for estimated GFR (eGFR, see below).
Cystatin C-based eGFR provides an alternative when creatinine-based estimates are not appropriate.
c. In at-risk adults (>18 years old) including those who have diabetes, cardiovascular disease, hypertension, previous kidney damage, systemic disease with potential kidney involvement (eg, systemic lupus erythematosus), or a family history of CKD, as well as individuals who are moderately obese or ≥65 years old.
Albuminuria indicates increased glomerular permeability, a characteristic of chronic kidney disease, and is assessed with either the urine albumin-creatinine ratio or albumin excretion rate over 24 hours. The urine albumin-creatinine ratio obtained from a random sample is more convenient and appropriate in the context of chronic kidney disease. However, carefully performed 24-hour specimen collection is more accurate and appropriate in some circumstances (eg, in glomerular disease when small discrepancies between the random and 24-hour results may influence high-risk therapeutic dosing). 9
Being less influenced by diet and muscle mass, cystatin C-based eGFR testing is appropriate for patients in whom creatinine-based results may be misleading. 5 These patients include pregnant women, patients with acute illness, patients with serious comorbid conditions, people with extremes of muscle mass (eg, bodybuilders, patients with amputation, paraplegia, muscle-wasting disease, or a neuromuscular disorder), patients suffering from malnutrition, those with a vegetarian or low-meat diet, and those taking creatine dietary supplements.
Our specialists at Labcorp are sharing research results and working to increase awareness about chronic kidney disease through a strategic alliance with the National Kidney Foundation. We can help deliver answers for clinicians and their patients to enable better care.
Kidneys are functioning well, but signs of initial damage are typically indicated by a protein called albumin 4 detected in urine (albuminuria).
Mild loss of kidney function is evident and albuminuria or other signs of kidney damage are also present.
Visible signs and symptoms, such as swelling, fatigue, reduced appetite, and other complications can occur in some patients, who must prepare for potential end-stage renal failure and dialysis.
Visible signs and symptoms, such as swelling, fatigue, reduced appetite, and other complications can occur in some patients, who must prepare for potential end-stage renal failure and dialysis.
Dialysis or a kidney transplant is required at this very serious stage.
Alfego D, Ennis J, Gillespie B, et al. Chronic Kidney Disease Testing Among At-risk Adults in the U.S. Remains Low: Real-World evidence From a National Laboratory Database. Diabetes Care. 2021;44:1-8.
The nitrogenous wastes are increased when the kidneys are not functioning normally. Being part of the protein metabolism, urea (in particular) are wastes that should not be retained in the blood. Thus, if any of these blood components are increased, the lab test will tell the physician of a renal problem.
In routine, the patient is ordered to go on fasting for at least 8 hours to a maximum of 10 hours. No food or water should be taken before the tests; a small amount of blood (perhaps 5 ml) is extracted from the patient and the blood is run through a machine that determines the said components in the blood.
Other indicators in routine urinalysis that can help in the diagnosis include specific gravity and color of the urine. Urinary sediments such as hyaline casts and/or muddy brown granular casts are also equally important indicators in routine urine analysis.
As part of the diagnostic procedure, a physician may order parathyroid hormone tests to evaluate the function of the parathyroid glands. This is in connection with the cascading effects from poor phosphorus metabolism by the kidneys that in turn may affect calcium metabolism and parathyroid hormone release.
Important indicators in Complete Blood Blount include hemoglobin and hematocrit counts. Additionally, other blood analyses are important to conclude anemia such as iron and serum ferritin tests.
The presence of indicators, particularly albumin/protein in the urinalysis may rule in chronic kidney disease. Microalbumin in the urine that is not associated with certain diseases such as urinary tract infection may indicate serious renal consideration.
As its name implies, FBS is done after the patient at least has undergone a minimum of 8-hour fasting.
Explain to patients that avoiding alcohol and nephrotoxins will help slow CKD progression. If a patient smokes, work with him or her to develop an individualized cessation plan.
CKD is a structural and/or functional abnormality of the kidney that lasts 3 months or longer. It’s a progressive and chronic condition that affects many aspects of the patient’s health.
GFR is automatically calculated and reported by laboratories as part of serum results (for example, as part of a comprehensive metabolic panel). Labs calculate the rate using the Modification of Diet in Renal Disease or the Chronic Kidney Disease Epidemiology. Collaboration formulas.
Psychological needs. Keep in mind that patients with CKD are at risk for many psychosocial issues, such as anxiety, depression, and stress.
In collaboration with patients and providers, nurses help deliver treatment by assessing, planning, implementing, and evaluating care plans. For example, if your patient is experiencing fluid overload, you may need to carry out provider orders that include applying fluid restrictions and/or administering diuretic medications. Electrolyte imbalances may require dietary changes and/or medication administration. Use the nursing process when performing these treatments, and frequently and promptly communicate with patients and providers to help improve outcomes. Your accurate and thorough nursing assessment data will help in revising treatment plans to ensure that patients meet goals. These data should include vital signs, including pain and pulse oximetry levels, intake and output, weight, mental status, energy level, reflexes, skin color and integrity, presence of blood in sputum and stools, heart and lung sounds, psychological status and needs, and the patient’s ability to accomplish activities of daily living.
CKD complications include heart failure, hypertension, hypervolemia, arrhythmias, anemia, pulmonary edema, anorexia, seizures, stroke, convulsions, coma, renal osteodystrophy, amenorrhea, and erectile dysfunction. CKD also can advance to end-stage renal disease (ESRD). Patients with ESRD may die from complications of their disease, typically from cardiovascular-related events.
age 60 or older and ethnicity (African American, American Indian, Asian, Pacific Islander, or Hispanic). Early-stage CKD can be asymptomatic, so recognizing risk factors and alerting patients and providers to them is crucial for prevention, early diagnosis, and optimal disease management.
In Stage 3 CKD, your kidneys have mild to moderate damage, and they are less able to filter waste and fluid out of your blood. This waste can build up in your body and begin to harm other areas, such as to cause high blood pressure, anemia and problems with your bones. This buildup of waste is called uremia.
You might think of Stage 3 CKD as a "middle stage" of kidney disease. Your kidneys are damaged, but they still work well enough that you do not need dialysis or a kidney transplant.
Some people with Stage 3 CKD do not have any symptoms. But for many people with CKD, Stage 3 is when their kidney disease begins to affect their health, and they start to notice symptoms.
It is common for people to find out they have CKD when they are in Stage 3 because this is when many people first have symptoms of kidney disease.
To try and find out what caused your CKD, your doctor may do other tests, including:
Doctors treat Stage 3 CKD with medicines that help with your symptoms and with other health problems kidney disease can cause, such as diabetes and high blood pressure.
Healthy life changes can make a big difference in how you feel and can help keep your kidneys working well for as long as possible. Eating kidney-friendly foods in the right amounts is one of the best ways to slow the damage to your kidneys from CKD and to feel your best.