![]() ![]() Procedures for mGFR often do not agree with each other and have not only wide population variation (as do plasma creatinine and cystatin C), but also much wider within-individual variation than creatinine or cystatin C. However, all comparisons between eGFR and mGFR have shown wide scatter that appears to be related to the large variability of the mGFR compared to the relatively stable plasma creatinine concentration. Because these methods are all lengthy and expensive, the MDRD estimated GFR (eGFR) calculation based on the creatinine concentration was introduced in 1999 as a more convenient parameter to assess kidney function, with the equation updated in 2009 (CKD-EPI eGFR). Interventions proved to slow the progression of chronic kidney disease include blood pressure control, glycemic control, and reduction of proteinuria with an angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker.Ī low-density lipoprotein goal of less than 100 mg per dL (2.60 mmol per L) is recommended for patients with chronic kidney disease, because these patients are statistically at highest risk for cardiovascular disease.Ī blood pressure goal of 130/80 mm Hg is recommended in patients with normal urinary albumin concentrations, and a blood pressure goal of 125/75 mm Hg is recommended in patients with proteinuria equal to or greater than 1 g per 24 hours.Methods for measuring glomerular filtration rate (GFR) have used either creatinine, inulin, iothalamate, 51Cr-EDTA, or iohexol as markers. Instead of a timed urine collection, a random urine sample for the microalbumin-creatinine or protein-creatinine ratio should be used to quantify proteinuria. Primary care physicians have an important role in detecting chronic kidney disease early, in instituting measures to slow disease progression, and in providing timely referral to a nephrologist.Īll adults with risk factors for chronic kidney disease should be screened with a serum creatinine determination for GFR estimation and analysis of a random urine sample for proteinuria. These goals include slowing disease progression, detecting and treating complications, and managing cardiovascular risk factors. The KDOQI guidelines define major treatment goals for all patients with chronic kidney disease. When chronic kidney disease is detected, an attempt should be made to identify and treat the specific underlying condition(s). ![]() In most clinical situations, analysis of random urine samples to determine the albumin-creatinine or protein-creatinine ratio has replaced analysis of timed urine collections. The glomerular filtration rate, calculated by using a prediction equation, detects chronic kidney disease more accurately than does the serum creatinine level alone the glomerular filtration rate also is used for disease staging. Guidelines from the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) recommend estimating glomerular filtration rate and screening for albuminuria in patients with risk factors for chronic kidney disease, including diabetes, hypertension, systemic illnesses, age greater than 60 years, and family history of chronic kidney disease. Unfortunately, chronic kidney disease often is overlooked in its earliest, most treatable stages. Evidence suggests that progression to kidney failure can be delayed or prevented by controlling blood sugar levels and blood pressure and by treating proteinuria. Diabetes and hypertension are the underlying causes in most cases of chronic kidney disease. Chronic kidney disease affects approximately 19 million adult Americans, and its incidence is increasing rapidly.
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