# Stage *** Chronic Kidney Disease 2/2 ***
G1 (>90) / G2 (60-90) / G3a (45-60) / G3b (30-45) / G4 (15-30) / G5 (<15 or on dialysis)
-- GFR Trend: ***
-- Symptoms: *** fatigue, n/v, anorexia, pruritis, AMS, peripheral neuropathy, bleeding, edema, dyspnea
-- Red Flags: *** sudden drop, overload, AMS c/f uremia, bleeding, electrolyte imbalance
-- Meds: *** NSAIDs, acyclovir, PPI, ACE/ARB, diuretics, bactim, etc.
-- Etiology DDx: *** diabetes (47%), HTN (28%), glomerular disease (7%), cystic kidneys (3%), other - polycystic kidney disease, NSAID use, amyloid, idiopathic (15%)
-- Initial Diagnosis: *** repeat creatinine and send Cystatin C to confirm a consistent decrease in GFR over a 3 month period; Labs - CBC, calcium, phos, A1c, urinalysis, Albumin:Cr, Protein:Cr, PTH, VitD, iron studies, HCV; Imaging - renal ultrasound
-- Monitoring: *** q4-12 month creatinine and BMP; Annual CBC, Albumin:Cr and Protein:Cr ratios, PTH, VitD, iron studies
-- Refer to Renal: *** GFR <30-45, acute decrease in GFR, Alb:Cr >300, resistant HTN
-- BP Control: *** (goal <130/80; ACE/ARB best, then CCB, then thiazide if GFR >30)
-- Proteinuria: *** (goal <300mg/d; if higher add ACE/ARB)
-- Diabetes: *** (Goal A1c ~7%, metformin, SGLT2i if GFR >45, GLP-1 if GFR >30, insulin any GFR)
-- Statin: *** (all >50yo, diabetes, ASCVD risk >10%; dose reduce GFR <60)
-- Anemia/Iron: *** (Goal Hgb 10-11.5, replete when Tsat <30% and ferritin <500; IV preferred; consider EPO if Hgb <10 despite repletion)
-- Acidosis: *** (goal HCO3 >22; Sodium Bicarb 650-1300mg TID)
-- Bone Health: *** (If PTH elevated >2x ULN; goal phos <5.5 - restrict phos in diet, add sevelamer 800mg TID with meals; if on dialysis, supplement with calcium and vitamin D)
-- Nutrition: *** (Nephrocaps, fluid restrict PRN with sodium restriction <2g/day if edema)
-- Lifestyle: *** exercise, smoking cessation
-- Avoid NSAIDs, PPI, contrasted studies, blood draws in non-dominant arm; renally dose meds
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New Diagnosis of CKD
Based on your lab results, you have chronic kidney disease, which means your kidneys are not working at full capacity. This may be in part due to ***
Kidneys are important for filtering out toxins from our body and keeping an appropriate balance on fluids and electrolytes. As such, we wil periodically keep an eye on many of these levels, at least once per year.
The best ways to prevent worsening of kidney function include controlling blood pressure, diabetes, losing weight, stopping smoking, and avoiding medications that can damage the kidney like ibuprofen/naproxen (Advil/Aleve).
Chronic kidney disease (CKD) is either abnormal renal anatomy or function for >3 months and is commonly caused by HTN and diabetes. Kidneys are able to work at near normal capacity with very little reserve, thus patients often only present with symptoms and sequelae (including fluid overload, uremia, anemia, hyperkalemia, hyperphosphatemia, and acidosis) late in the course. Medications shown to help prevent the progression of CK D include ACE/ARBs and SGLT2 inhibitors. Other management is based on treating co-morbidities and managing the downstream effects of CKD. While CKD can be managed by primary care physicians, when the GFR is less than 30-45, there is an acute decrease in GFR or the Albumin:Creatinine ratio is >300, involving renal consultants for management and discussions of renal replacement therapy or transplant is likely warranted. Early referral is important because it takes around 6 months to prep for dialysis in the non-acute setting.