This is the updated guideline from NICE which looks at CKD. There is some stuff that as similar in this to previous guidelines, but a fair bit that is different. I have highlighted the main differences and why they have been made, then included a flow chart which covers the main features of management, then summarised some of the other important bits to be aware of.
Main Differences
eGFRcystatinC
Cystatin C is a protein that is filtered out through the kidney. Traditionally eGFR has been estimated using creatinine clearance (eGFRcreatinine), but this isn’t very accurate in mild CKD and doesn’t distinguish CKD from normal ageing processes. It is also highly variable with muscle mass and protein intake. Cystatin C gets around these issues – but is more expensive. Therefore the new guideline advises using eGFRcystatinC to confirm a diagnosis of CKD when the eGFRcreatinine is 45-59 and there are no other markers of renal disease (see the flowchart below). For the rest of this summary, where I use eGFR, I mean eGFRcreatinine. It is worth noting that hypothyroidism or hyperthyroidism can give an inaccurate eGFRcystatinC.
Proteinuria
Use ACR rather than PCR or reagent strips (unless they are capable of giving an ‘ACR’ reading and can measure albumin at low levels).
