Preventive activities in general practice 7th edition

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Screening tests of unproven benefit

Appendices

Disclaimer

Kidney disease

Kidney disease age range table

Age

0 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 79

>80

Screening for kidney disease is recommended every year starting at 50 years of age (B). Screening should include BP and urinalysis.^337,338 Patients at high risk should be screened every 12 months and should also have glomerular filtration rate (GFR) estimated from serum creatinine, age and gender.^339,340

Kidney disease risk
Who is at higher risk of kidney disease?	What should be done?	How often?	Level of evidence and references
Increased risk Age >50 years Smoking	BP, urinalysis	Every 5 years	III B 322,341,342
High risk Hypertension Obesity³⁴³ Family history of kidney disease Diabetes Aboriginal people or Torres Strait Islanders >35 years of age	BP, urinalysis, microalbumin,³⁴⁴ and GFR If positive, arrange two further samples for urine albumin:creatinine ratio over 2 months	Every 12 months (microalbumuria testing should be performed every 3 years; patients with diabetes, every 12 months)	III A 309,345-347
III B 309,321,341 348,349

Kidney disease risk

Who is at higher risk of kidney disease?

What should be done?

How often?

Level of evidence and references

Increased risk

Age >50 years
Smoking

BP, urinalysis

Every 5 years

III B 322,341,342

High risk

Hypertension
Obesity³⁴³
Family history of kidney disease
Diabetes
Aboriginal people or Torres Strait Islanders >35 years of age

BP, urinalysis, microalbumin,*³⁴⁴ and GFR

* If positive, arrange two further samples for urine albumin:creatinine ratio over 2 months

Every 12 months (microalbumuria testing should be performed every 3 years; patients with diabetes, every 12 months)

III A 309,345-347

III B 309,321,341

348,349

Kidney disease Test
Test	Technique	References
Urinalysis	Dipstick test on random urine sample for proteinuria. Proteinuria present if dipstick 1+ or more
Micro-albuminuria	Spot, untimed collection of urine for calculation of urine albumin:creatinine ratio NB: dipstick urine test is NOT adequate to identify microalbuminuria Urine albumin:creatinine ratio	341
Females	Males
Normal <3.6 mg/mmol Microalbuminuria 3.6–35.0 mg/mmol Macroalbuminuria >35.0 mg/mmol	<2.6 mg/mmol 2.6–25.0 mg/mmol >25.0 mg/mmol
eGFR	This is usually automatically reported with every test for serum creatinine using the abbreviated modification of diet in renal disease (MDRD) formula: eGFR (mL/min/1.73 m2 ) = 175 x serum creatinine (µmol/L)/88.4–1.154 x (0.742 if female) x (1.21 if Afro-American) An automated calculator for MDRD may be found at www.kidney.org.au	348
Staging of chronic kidney disease: Stage 1 >90 mL/min/1.73 m2 with proteinuria or haematuria Stage 2 (mild) 60–89 mL/min/1.73 m2 with proteinuria or haematuria Stage 3 (moderate) 30–59 mL/min/1.73 m2 Stage 4 (severe) 15–29 mL/min/1.73 m2 Stage 5 (end stage) <15 mL/min/1.73 m2	350
Refer patients with stage 4 or 5 to a renal unit or nephrologist and consider referral at stage 3 or earlier (eg. if proteinuria >1 g or rapidly deteriorating GFR) See the Chronic Kidney Disease CKD Management in General Practice guidelines The eGFR may be unreliable in the following situations (it has not been validated in all ethnic groups): acute changes in renal function dialysis patients certain diets (eg. vegetarian, high protein, recent ingestion of cooked meat) extremes of body size muscle diseases (may underestimate) or high muscle mass (may overestimate) children <18 years of age severe liver disease	348

Kidney disease Test

Test

Technique

References

Urinalysis

Dipstick test on random urine sample for proteinuria. Proteinuria present if dipstick 1+ or more

Micro-albuminuria

Spot, untimed collection of urine for calculation of urine albumin:creatinine ratio
NB: dipstick urine test is NOT adequate to identify microalbuminuria
Urine albumin:creatinine ratio

341

Females

Males

Normal <3.6 mg/mmol
Microalbuminuria 3.6–35.0 mg/mmol
Macroalbuminuria >35.0 mg/mmol

<2.6 mg/mmol
2.6–25.0 mg/mmol
>25.0 mg/mmol

eGFR

This is usually automatically reported with every test for serum creatinine using the abbreviated modification of diet in renal disease (MDRD) formula:

eGFR (mL/min/1.73 m2 ) = 175 x serum creatinine (µmol/L)/88.4–1.154 x (0.742 if female) x (1.21 if Afro-American)

An automated calculator for MDRD may be found at www.kidney.org.au

348

Staging of chronic kidney disease:
- Stage 1 >90 mL/min/1.73 m2 with proteinuria or haematuria
- Stage 2 (mild) 60–89 mL/min/1.73 m2 with proteinuria or haematuria
- Stage 3 (moderate) 30–59 mL/min/1.73 m2
- Stage 4 (severe) 15–29 mL/min/1.73 m2
- Stage 5 (end stage) <15 mL/min/1.73 m2

350

Refer patients with stage 4 or 5 to a renal unit or nephrologist and consider referral at stage 3 or earlier (eg. if proteinuria >1 g or rapidly deteriorating GFR)

See the Chronic Kidney Disease CKD Management in General Practice guidelines

The eGFR may be unreliable in the following situations (it has not been validated in all ethnic groups):

acute changes in renal function
dialysis patients
certain diets (eg. vegetarian, high protein, recent ingestion of cooked meat)
extremes of body size
muscle diseases (may underestimate) or high muscle mass (may overestimate)
children <18 years of age
severe liver disease

348

Guidelines for preventive activities in general practice 7th edition

Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Kidney disease