Your SlideShare is downloading. ×
Screening
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Screening

5,894
views

Published on

MSN Screening for CKD …

MSN Screening for CKD

Published in: Health & Medicine

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
5,894
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
297
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Transcript

    • 1. Early Detection Of Renal Disease
    • 2.
      • Asymptomatic urine abnormalities :
      • proteinuria/ haematuria
      • Nephritic/Nephrotic syndrome
      • Hypertension
      • Unexplained anaemia
      • Incidental finding of elevated serum Creatinine
      • Uraemic emergencies
      Common clinical presentations of kidney disease
    • 3.
      • Serum creatinine
      • Estimated glomerular filtration rate (GFR)
      • Urine testing :
      Screening method
      • Urine dipstick
      • Urine microscopic examination
      • Urine microalbuminuria
    • 4.
      • Sr creatinine is poor reflection of early renal disease/failure
      • Damage < 60% sr creatinine still normal
      • Almost all early renal failure patients are asymptomatic
      • SCREENING IS THEREFORE VERY IMPORTANT
      Screening method Serum Creatinine
    • 5. Relationship between serum creatinine and GFR
    • 6. 1.23 x (140-Age) x BW Sr Cr (umol/l) 1.04 x (140-Age) x BW Sr Cr (umol/l) Estimated Glomerular Filtration rate Man Woman Screening method Estimated GFR
    • 7.
      • Urine for protein
          • Dipstick
          • 24 hour urinary protein
      • Urine microscopic examination
          • For RBC / Pus Cell / Cast
      • Urine for microalbuminuria
          • On morning urine sample
          • using strip for microalbumin
      Screening methods Urine testing
    • 8. Screening methods Microalbuminuria testing
    • 9.
      • Mass population screening is not cost effecive
      • Screening of high risk groups to develop renal disease/failure
      Target groups for screening
    • 10.
      • Renal calculi
      • Anemia of unknown aetiology
      • First and second degree relatives of ESRD
      • Autoimmune disease (SLE/RA)
      • Reduction of kidney mass(Nephrectomy )
      • Hypertensive patients
      • Diabetic patients
      • Cardiovascular disease
      • Proteinuria
      • Hematuria
      • Those on regular NSAID/Herbs
      Screening renal disease The High Risk Groups
    • 11. Screening of renal disease : Hypertensive patients UFEME BUSE/Cr USS KUB Other test Young hypertensive Yearly Yearly UFEME BUSE/Cr All hypertensive Frequency Screening tests
    • 12.
      • BP
      • Urine Protein
      • Urine Microalbuminuria
      • BUSE/Creatinine yearly if normal
      When to screen Methods Screening of renal disease Diabetic Patients Type 1 Type 2 DM 5 years after diagnosis (age >12) Or earlier if CV risk yearly At diagnosis Frequency First screening
    • 13. Urine dipstick for protein Positive (Urine protein >300mg/l) On 2 separate occasions (exclude other causes) Overt Nephropathy Quantify excretion rate 24HUP Negative Screen for Microalbuminuria (on early morning spot urine) Negative Yearly test Positive Retest twice in 3-6/12 Exclude other cause If 2 of test are positive Diagnosis of microalbuminuria Is established 3-6 monthly follow-up of microalbuminuria Optimise glycaemic control Strict Bp control ACE/ARB Stop smoking Lifestyle modification Treat hyperlipidaemia Avoid excessive protein intake Monitor renal function Monitor other endorgan damage Algorithm: Screening for proteinuria/microalbuminuria in DM
    • 14. Proteinuria is a major manifestation of renal disease Screening of renal disease Proteinuria <20 <30 Normoalbuminuria >35 women >25 men >200 >200 >300 Overt Proteinuria 3.5-35 women 2.5-25 men 20-200 20-200 30-300 Microalbuminuria Urine Albumin:creatinine ratio (mg/mmol) Urine Albumin Concentration (mg/l) <3.5 women <2.5 men <20 First voided morning specimen Timed Collection (ug/min) 24 hr Collection (mg/24h) Specimen collected Albumin Excretion
    • 15.
      • Urinary Tract Infection
      • Sepsis
      • Heart Failure
      • Strenous exercise
      • Heavy protein intake
      • Menses
      Causes of false positive proteinuria
    • 16.
      • A dominant risk factor for deterioration of renal failure (besides HT)
      • Marker of Increased Risk for CV mortality and morbidity (DM & non-DM)
          • e.g. Microalbuminuria is associated with a 100- 150% increase in death rate
      • (Mogensen CE, New Eng. J. Med 1984;310:310-60)
      Significance of Proteinuria
    • 17. History Physical Examination Urine Examination of Urinary sediment Abnorma l refer to a nephrologist Normal Repeat visit for a Qualitative proteinuria test Positive Do Renal profile Quantitate urinary protein Refer to nephrologist Negative Transient proteinuria Reassure Evaluation of persistent proteinuria
    • 18.
      • Definition:
      • > 3-5 rbc/hpf on urinary sediment examination
      • In clinical practice can be diagnosed by urine dipstick test
      • False positive
      • povidone-iodine
      • oxidising agents
      • False negative
      • vit C excretion
      • air-exposed dipsticks
      Screening of renal disease Hematuria
    • 19. Detection of Microscopic hematuria >5RBC/hpf or +ve dipstik test
      • Primary care investigation
      • History
      • Examination
      • Renal function
      • Urine microscopy and culture
      Urological referral
      • Urological investigation
      • Radiological imaging
      • Cystourethroscopy
      Diagnosis And Treatment
      • Menstruating women
      • Women with UTI
      • False +ve resul suspected
      • Recent strenous exercise
      • Proteinuria
      • Red cell cast
      • Renal Impairment
      • Nephrological referral
      • Observation
      • Investigation
      • Renal biopsy
      No diagnosis
      • GP follow-up
      • Biennial urinalysis and BP
      Evaluation of asymptomatic hematuria
    • 20.
      • 1. Proper investigation and accurate diagnosis
      • - definitive diagnosis relevant for:
      Benefits of early detection a) specific disease treatment e.g. immunosuppression b) future transplant – timing, risk of recurrent disease etc c) counselling and screening of relatives
    • 21.
      • 2. Allows measures to retard disease progression to be instituted and maximised
      • 3. Complications associated with failing
      • renal function can be addressed:
      Benefits of early detection
      • anaemia
      • renal bone disease,
      • malnutrition
    • 22.
      • 4. Enables timely referral to nephrologists
      Benefits of early detection
      • Adequate time for preparation of patients for renal replacement therapy
      • Avoids the increased mortality and morbidity associated with temporary dialysis catheters and IPD
      • education regarding options
      • timely creation of AVF
      • placement of Tenckhoff catheters
    • 23. Studies on Early vs late referral AV access use at initiation of HD increased with earlier referral time 499 ER < 1 mo LR > 12 mo USA 1995-1998 CHOICE study LR > ER 78 106 ER > 3 mo LR < 1 mo Brazil 1992-1995 Sesso et al LR > ER 2264 ER > 4 mo LR < 4 mo Texas 2002 Stack et al LR > ER 325 325 ER > 4 mo LR < 4 mo Edinburgh 1987-1992 Eadington et al LR > ER 153 65 ER > 6 mo LR < 1 mo Paris 1989-1991 Jungers et al LR > ER 32 23 ER > 1 mo LR < 1 mo Oxford 1981 Ratcliffe et al Mortality risk Mean length of hospital stay (days) No of patients Timing of referral Location/ year Source
    • 24. THANK YOU