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New eGFR 60-89

  • Patients only have Chronic Kidney Disease (CKD stage 2) if they also have either
  • proteinuria or
  • haematuria or
  • structurally abnormal kidneys (eg glomerulonephritis, polycystic disease)

Next -

  • Send urine for ACR
  • Test urine - for blood
  • If none of the above and eGFR is stable then no further specific action is needed, unless otherwise indicated.

What do to about positive results of urine testing

Send blood for eGFR

Urine test results:

Protein only or Protein and Blood

 

Measure the eGFR and then if

If suspected Nephrotic syndrome (ACR > 250 and low serum albumin) - urgent referral

 

Management of asymptomatic invisible haematuria

Age > 40 years

  • urine stick test: blood +ve - refer to Urology
  • urine stick test: blood +ve and urology investigation negative then consider referral

Age < 40 years

  • urine stick test: blood +ve, ACR < 30 - consider referral
  • urine stick test: blood +ve, ACR > 30 - refer to Renal Medicine

 

Visible haematuria

Urology referral

 

What should I do if CKD Stage 2 and eGFR stable?

At least annual measure of eGFR and urine ACR

  • if eGFR falling by > 4 ml/yr then consider referral
  • if ACR > 70 - consider referral

 

General health advice as appropriate on:

smoking cessation aerobic exercise
weight loss limiting alcohol and sodium intake

 

Cardiovascular Prophylaxis

If 10 year risk of cardiovascular disease of > 20% consider:

  • Lipid-lowering drug therapy (or entry into a trial)

 

Blood pressure monitoring and hypertension control

Blood pressure should be measured according to BHS standards at least annually and should be meticulously controlled. Threshold for initiation of anti-hypertensive medication:

  • If urine ACR < 70 mg/mmol, treatment threshold 140/90 mmHg – Target 130/80

  • If urine ACR > 70 mg/mmol, treatment threshold 130/80 mmHg – Target 125/75

Use ACEIs or ARBs if