Diagnosing Chronic Kidney Disease

    Published: 06-16-2009
    Views: 15,434
    Dr. Leslie Spry from the National Kidney Foundation discusses diagnosing chronic kidney disease.

    Leslie Spry: My name is Leslie Spry, and I am a kidney specialist in Lincoln, Nebraska. I am here today on behalf of the National Kidney Foundation to talk with you about understanding chronic kidney disease and this will introduce you to early diagnosis and diagnostic criteria.

    Patients who have chronic kidney disease need to be appropriately screened. The most common reason why someone who has chronic kidney disease continues to be either high blood pressure or diabetes, one of the tests that needs to be done in relationship to diagnosing chronic kidney disease is the measurement of blood pressure. Elevated blood pressure will result in an acceleration of Kidney disease and more rapid deterioration of kidney function.

    A normal blood pressure is 120 over 80, that is normal. Anything less than that is normal. A borderline blood pressure is between 120 and 130 with the bottom number or diastolic number being between 80 and 90. If the blood pressure is in that range, it should be monitored but not necessarily treated. Blood pressures that are 140 over 90 or higher should clearly be treated especially if they are measured on a repetitive basis.

    Treatment is important in this case because high blood pressures with pressure in excessive 140 over 90 may be associated with more rapid deterioration in kidney function. Other tests that are important to be done are urine protein testing. Urine protein such as, are very specific protein known as albumin, maybe present in increase concentrations in urine that further indicates a progression of kidney disease. If the urine protein and specifically urine albumin concentration is in excess of 30 milligrams per gram of Creatinine. this indicates a damage to certain filters inside of the Kidney known as Glomeruli, which will result in their destruction. We next turn to a blood test which is known as Creatinine. Creatinine is a byproduct of muscle metabolism that circulates in the blood at all times. That byproduct is ultimately eliminated by the kidney. We measure Creatinine in the blood and it allows us to estimate kidney function through a calculation known as a GFR test which is known as a Glomerular Filtration Rate test. We estimate that rate which is approximately equivalent to a percent kidney function.

    Normal percent kidney function is greater than 90. Modest Kidney problems are indicated by a level between 60 and 90, and more significant kidney problems are present if your GFR test is below 60. Once we see GFR testing below 60, that is extremely significant and needs to be addressed by your physician.

    Milder levels of kidney function maybe just associated with the natural aging process and perhaps don't need as aggressive management. In general, GFR test below 30 and specifically GFR test below 15 may require certain interventions such as dialysis or transplantation. The early diagnosis of chronic kidney disease is extremely important. The National Kidney Foundation started the project in early 2000 that attempted to diagnose kidney disease early. This is known as the KEEP project which stands for Kidney Early Evaluation project.

    Since 2000, we have been generating annual data that allows us to diagnose early chronic kidney disease by screening individuals who have risk factors for kidney disease or who have known kidney disease. We currently have very good treatments for early kidney disease and the KEEP project is an effort to try to diagnose kidney disease early to allow early intervention.

    Next, we will be discussing things that need to be done in order to treat patients who have chronic kidney disease. We'll specifically address changes that need to be made in lifestyle and specific treatments that are necessary for chronic kidney disease.