Management of Stage 3 CKD

• Blood Tests (Renal Profile) 6 to 12 monthly for estimation of :
  • Creatinine and Potassium - consider an unxexplained fall in eGFR of >25% to be acute renal failure. NICE suggest seeking specialist advice for a loss in GFR over 1y of 5ml/min, or a loss of GFR in 5y of 10ml/min
  • Hb (in CKD 3B) - if low, exclude non-renal cause. Below 11.0 g/dl, specific therapy may be considered to improve quality of life. Hb falls progressively as GFR falls, but renal anaemia rarely becomes significant before stage 3B or 4 CKD.
  • Urinary protein for ACR or PCR. Note thresholds; ACR 30 or PCR 50 for more stringent blood pressure targets, and ACR 70 or PCR 100 for  re-referral/discussion.
  • Blood pressure - 140/90 max (130-139/90), or 130/80 max (120-129/80) for patients with proteinuria: urinary ACR>30 or PCR>50
  • Cardiovascular risk - advice on smoking, exercise and lifestyle. Consider cholesterol lowering therapy if already have macrovascular disease, or if estimated 10 year risk of cardiovascular events =/>20%.
  • Immunization - influenza and pneumococcal
  • Medication review - regular review of medication to minimise nephrotoxic drugs (particularly NSAIDs) and ensure doses of others are appropriate to renal function.

For further advice go to website :

http://www.gloshospitals.nhs.uk/en/Wards-and-Departments/Departments/Nephrology/Referral-Guidelines-Nephrology/

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