Download Chronic kidney disease

Chronic kidney disease
Recommend
 Consider essential screening of ‘at risk’ population groups as kidney disease and failure are often
asymptomatic
 Treat all patients with Type 1 or Type 2 diabetes mellitus complicated by microalbuminuria or overt
nephropathy with an ACE inhibitor (ACEI), independent of BP and GFR [1]
Related topics:
 Diabetes, page 332
 Hypertension, page 334
 Urinary tract infections (adult, child and in pregnancy), pages 278, 410, 592
 Acute post streptococcal glomerulonephritis, page 537
1.
May present with:
 Diagnosis of chronic kidney disease
2.
Immediate management: not applicable
3.
Clinical assessment:
The assessment process includes:
 Take complete patient history including medication history
 family history of diabetes, kidney disease or other risk factors
 Perform standard clinical observations + weight, height
 venous BGL and FBC, fasting cholesterol / triglycerides / LDL / HDL, serum creatinine, urinalysis
for protein and blood, followed by urine collection for albumin creatine ration (ACR) and MCS if
applicable

Physical examination

Assess absolute cardiac risk Assess absolute cardiac risk - Absolute cardiovascular disease risk
assessment available at National Heart Foundation of Australia 2009
http://www.heartfoundation.org.au/SiteCollectionDocuments/A_AR_QRG_FINAL%20FOR%20WEB
.pdf
4.
Management:
 BP control is the most important measure in slowing kidney disease progression - aim for BP<
125/75. The rate of kidney function decline is accelerated by hypertension [3]
 Treat underlying cause and prevent or slow progression
 Stress that symptoms are generally uncommon and consequences of kidney disease occur many
years in the future
MO may advise initiation or re-supply of medications:
 Antihypertensives - angiotension converting enzyme inhibitors (ACEI’s) are the mainstay of
treatment, associated with a reduction in proteinuria and slowing of the rate of progression to renal
failure [1]
 Combination of ACEI’s and angiotensin receptor blockers (ARB) may be more effective than a single
agent [4]
 Statin therapy should be prescribed for all people with diabetes [5]
 Metformin should not be used if creatinine is increased or GFR is decreased [3]
 Correct anaemia with erythropoietin
 Oral alkali replacement maybe required to manage acidosis
 Phosphate binder (calcium carbonate) and vitamin D metabolite (calcitriol) may be required to
manage parathyroid hormone levels.
Schedule
4
Renal drugs
Authorised Indigenous Health Workers must consult MO and supply under the conditions of the DTP
Nurse Practitioners may proceed
Route of
Form
Strength
Recommended Dosage
Administration
Tablet
As ordered by MO
Oral
As ordered by MO
Vitamin D metabolite Diuretic
Phosphate binder
Calcitriol
Frusemide
Caltrate
Hydrochlorothizide
Titralac
Indapanide
Aluminium hydroxide (Alutabs)
Management of Associated Emergency: Consult MO
5.
DTPIHW / NP
Duration
As ordered by MO
Follow up:
 According to Queensland Health current edition Chronic Disease Guidelines or local protocols if
outside Queensland
6.
Referral / Consultation:
 According to Queensland Health current edition Chronic Disease Guidelines or local protocols if
outside Queensland