The Kidney Disease Outcome Quality Initiative of the National Kidney Foundation published clinical practice guidelines on chronic kidney disease in February 2002. Of the 15 guidelines, the first six are of greatest relevance to family physicians. Part II of this two-part review covers guidelines 4, 5, and 6. Glomerular filtration rate is the best overall indicator of kidney function. It is superior to the serum creatinine level, which varies with age, sex, and race and often does not reflect kidney function accurately. The glomerular filtration rate can be estimated using prediction equations that take into account the serum creatinine level and some or all of specific variables (age, sex, race, body size). In many patients, estimates of the glomerular filtration rate can replace 24-hour urine collections for creatinine clearance measurements. Urine dipsticks generally are acceptable for detecting proteinuria. To quantify proteinuria, the ratio of protein or albumin to creatinine in an untimed (spot) urine sample is an accurate alternative to measurement of protein excretion in a 24-hour urine collection. Patients with persistent proteinuria have chronic kidney disease. Other techniques for evaluating patients with chronic kidney disease include examination of urinary sediment, urine dipstick testing for red and white blood cells, and imaging studies of the kidneys (especially ultrasonography). These techniques also can help determine the underlying cause of chronic kidney disease. Family physicians should weigh the value of the National Kidney Foundation guidelines for their clinical practice based on the strength of evidence and perceived cost-effectiveness until additional evidence becomes available on the usefulness of the recommended quality indicators.
[1]
G. Eknoyan,et al.
Clinical practice guidelines for chronic kidney disease in adults: Part I. Definition, disease stages, evaluation, treatment, and risk factors.
,
2004,
American family physician.
[2]
Kdoqi Disclaimer.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
,
2002,
American journal of kidney diseases : the official journal of the National Kidney Foundation.
[3]
David Roth,et al.
A simplified equation to predict glomerular filtration rate from serum creatinine
,
2000
.
[4]
A. Levey,et al.
A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation
,
1999,
Annals of Internal Medicine.
[5]
N. Madias,et al.
Serum creatinine as an index of renal function: new insights into old concepts.
,
1992,
Clinical chemistry.
[6]
J P Kriss,et al.
Limitations of creatinine as a filtration marker in glomerulopathic patients.
,
1985,
Kidney international.
[7]
Cockcroft Dw,et al.
Prediction of Creatinine Clearance from Serum Creatinine
,
1976
.