Renal Update

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Key Advisor: Professor Rob Walker
Full colour PDF of the pages as they appeared in ‘best practice’.
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Action plan for Chronic Kidney Disease
(Based on eGFR)

Get a PDF of this table here
eGFR
mL/min/1.73 m2		 Description Clinical action plan
≥ 60 No kidney damage
OR
Stage 1 CKD
(Kidney damage with normal or kidney function) ± proteinuria
OR
Stage 2 CKD
(Kidney damage with mild kidney function)		 Further investigation for CKD may be indicated in those at increased risk (smoking, diabetes, high blood pressure, age over 50 years, family history, Māori or Pacific Island or Asian heritage:
  • Assessment of proteinuria
  • Urinalysis
  • Blood pressure
Cardiovascular risk reduction (blood pressure, lipids, blood glucose, smoking, obesity, physical activity)
Blood pressure targets ≤ 130/80; ≤ 122/76 if protein > 1 g/24 hours
30 - 59 Stage 3 CKD –
Moderate kidney function		 As for Stage 2 plus:
  • Blood pressure control
  • Monitor eGFR 3 monthly
  • Avoid nephrotoxic drugs (e.g. NSAIDS, colchicine)
  • Prescribe antiproteinuric drugs (ACE inhibitors and/or angiotensin receptor blockers) if appropriate
  • Address anaemia, acidosis and hyperparathyroidism
  • Ensure drug dosages appropriate for level of kidney function (adjust according to Cockcroft-Gault equation)
Consider referral to nephrologist
15 - 29 Stage 4 CKD –
Severe kidney function		 As for Stage 3 plus:
  • Referral to nephrologist is usually indicated for preparation for dialysis (including access surgery, education) or transplantation
< 15 Stage 5 CKD –
End-stage kidney failure		 As for Stage 4 plus referral to nephrologist
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