{"id":6079,"date":"2023-04-18T15:57:17","date_gmt":"2023-04-18T15:57:17","guid":{"rendered":"https:\/\/edren.org\/ren\/?page_id=6079"},"modified":"2023-04-26T23:08:08","modified_gmt":"2023-04-26T23:08:08","slug":"lab-testing-in-kidney-disease","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/unithdbk\/ckd\/lab-testing-in-kidney-disease\/","title":{"rendered":"Lab testing in kidney disease"},"content":{"rendered":"<h2><strong>CKD monitoring<\/strong><\/h2>\n<p>NICE and KDIGO (international consensus guidelines in kidney disease) have recommended that the frequency of CKD monitoring is stratified according to GFR and uACR (urine albumin:creatinine ratio) as in the figure below.\u00a0 The numbers (1 &#8211; 4+) are the number of recommended blood tests per year.\u00a0 This is a reasonable starting point, but common sense and principles of realistic medicine should be applied.\u00a0 For example, in frail multi-morbid patients, it may be appropriate to perform no routine monitoring at all.<\/p>\n<p><a href=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-6083\" src=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48.png\" alt=\"\" width=\"1514\" height=\"1122\" srcset=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48.png 1514w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48-300x222.png 300w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48-1024x759.png 1024w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48-768x569.png 768w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/Screen-Shot-2023-04-03-at-11.52.48-150x111.png 150w\" sizes=\"auto, (max-width: 1514px) 100vw, 1514px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<h3><strong>NHS Lothian ICE CKD ordersets<\/strong><\/h3>\n<p>The ICE ordersets used in primary care in NHS Lothian for<span style=\"text-decoration: underline;\"><strong> CKD monitoring<\/strong><\/span> are:<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>eGFR &gt; 30: C&amp;Es<\/li>\n<li>eGFR &lt; 30: C&amp;Es, alb, Ca<sup>2+<\/sup>, PO4<sup>3-<\/sup>, FBC, urine albumin:creatinine ratio (uACR)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>The ICE ordersets for <span style=\"text-decoration: underline;\"><strong>CKD diagnosis<\/strong><\/span> are:<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>eGFR &gt; 30: C&amp;Es, total cholesterol, HDL-C, urine albumin:creatinine ratio (uACR)<br \/>\neGFR &lt; 30: C&amp;Es, total cholesterol, HDL-C, alb, Ca<sup>2+<\/sup>, PO<sub>4<\/sub><sup>3-<\/sup>, FBC, urine albumin:creatinine ratio (uACR)<\/li>\n<\/ul>\n<p>The rationale for checking lipids at time of diagnosis is that CKD is an indication for considering lipid-lowering therapy, and if these are started then a baseline lipid profile may be helpful (e.g. if targeting a 40% reduction in non-HDL cholesterol as per NICE).<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>More selected testing<\/strong><\/h3>\n<p>For many patients with CKD, if the likely cause is obvious (e.g. in context of longstanding hypertension \/ T2DM) then no diagnostic work-up is required.<\/p>\n<p>The following scenarios suggest where additional testing may be helpful:<\/p>\n<ul style=\"list-style-type: disc;\">\n<li><strong><span style=\"text-decoration: underline;\">suspected intrinsic kidney disease<\/span> <\/strong>(e.g. if there are features of a multisystem disease):\u00a0urine dip looking for blood and protein, spot urine sample for uACR (or uPCR), FBC, LFTs, Ca<sup>2+<\/sup> and discuss with renal (who may suggest autoantibodies, complement levels, viral serologies etc.); if there is a strong suspicion of an intrinsic renal disease then we will probably wish to review in the renal outpatient clinic and direct investigations from there<\/li>\n<li><strong><span style=\"text-decoration: underline;\">suspicion of myeloma<\/span><\/strong>: Ca<sup>2+<\/sup>, serum protein electrophoresis and a light chain assay (either urine Bence-Jones protein or serum free light chains); checking for both uACR and uPCR can be helpful (as the finding of a high uPCR but normal uACR would suggest overflow light chain proteinuria)<\/li>\n<li><strong><span style=\"text-decoration: underline;\">unexplained CKD<\/span><\/strong>: renal ultrasound scan (to look for kidney size \/ symmetry \/ obstruction \/ cysts&#8230;)<\/li>\n<li><strong><span style=\"text-decoration: underline;\">urinary tract symptoms \/ suspicion of prostatic disease<\/span><\/strong>: renal ultrasound scan<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>CKD monitoring NICE and KDIGO (international consensus guidelines in kidney disease) have recommended that the frequency of CKD monitoring is stratified according to GFR and uACR (urine albumin:creatinine ratio) as in the figure below.\u00a0 The numbers (1 &#8211; 4+) are the number of recommended blood tests per year.\u00a0 This is\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/unithdbk\/ckd\/lab-testing-in-kidney-disease\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":6,"featured_media":0,"parent":5365,"menu_order":14,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-6079","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6079","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=6079"}],"version-history":[{"count":7,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6079\/revisions"}],"predecessor-version":[{"id":6142,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6079\/revisions\/6142"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/5365"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=6079"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}