1. Early detection of renal disease is important through screening methods like urine and blood tests as most early renal failures are asymptomatic. 2. High risk groups for renal disease include those with diabetes, hypertension, cardiovascular disease, urinary tract infections, and a family history of kidney disease. These groups should be regularly screened. 3. Screening allows for early treatment and measures to slow disease progression, reducing complications and allowing time for education and vascular access planning for renal replacement therapy if needed. Benefits of early detection include better outcomes.

1. Early Detection Of Renal Disease

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

8. Screening methods Microalbuminuria testing

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

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

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

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

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