Proteinuria

Question 1

What should be used ACR or PCR?

Answer 1

ACR

Question 2

When should you collect an ACR sample?

Answer 2

First pass morning urine specimen.

Question 3

How should you interpret ACR results for non-diabetics?

Answer 3

• If ACR <30mg/mmol = not clinically significant.
• If ACR between 30mg/mmol-70mg/mmol = repeat sample. If repeat is positive then refer to nephrology.
• If ACR > 70mg/mmol = Refer to nephrology

Question 4

How should you interpret ACR results in a diabetic patient?

Answer 4

• ACR > 2.5mg/mmol in men is clinically significant.
• ACR >3.5mg.mmol in women is clinically significant.

And warrant a referral to nephrology

Question 5

In CKD, who should have a renal ultrasound?

Answer 5

• Accelerated progression of CKD
• Persistent invisible haematuria
• Symptoms of urinary tract obstruction
• Family history of polycystic kidney disease
• GFR category G4 or G5 (Stage 4 and 5)

Question 6

What are the staging guidelines we now use to measure CKD?

Answer 6

KDIGO Guidelines

CKD is now defined according to both eGFR and ACR.

G= GFR

A=ACR.

e.g G4A2

Question 7

What are the at risk groups of developing CKD?

Answer 7

• Diabetes and/or Hypertension
• Renal
  
  • Structural kidney disease
  • Recurrent calculi
  • Prostatic hypertrophy
  • Family history of hereditary kidney disease or G5
• Multisystem disease with potential renal involvement
  
  • E.g. SLE etc
• Opportunistic discovery of invisible haematuria
• Patients prescribed nephrotoxic drugs
  
  • Lithium
  • NSAIDs
  • Cyclosporin etc

Question 8

What 2 conditions can cause a temporary rise in proteinuria?

Answer 8

Proteinuria may be increased by a factor of 2-3 times by strenuous exercise or fever.

Question 9

What are your 3 key strategies to managing CKD?

Answer 9

1. Make patient aware of the diagnosis and self management
   
   • Patient leaflets
   • Patient View - for a patient to track and share their results.
   • Exercise and weight loss help.
   • Maintain adequate protein intake.
2. Checking for rapidly progressive disease
   
   • See question on how often to monitor.
   • ​Decrease of GFR of 15/year.
   • A sustained decrease in GFR of >=25%(in a minimum of 3 tests over a period of at least 90days) and a change in G category
   • Extrapolate their progression to see if they will need dialysis in their lifetime.
3. Reducing CVD risk
   
   • see questions slide on reducing CVD risk.

Question 10

How often should you monitor CKD?

Answer 10

• Stages G1 to G3a, at least annually
  
  • Stage G3aA3 twice
• Stages G3b to G4, at least twice annually
  
  • Stage G4A3 three times
• Stage G5 kidney failure, at least 4 times a year

Question 11

How do we reduce cardiovascular risk in patients with CKD?

Answer 11

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