Chronic Kidney Disease Malaysian CPG 2011

CHRONIC KIDNEY DISEASE

Based on Malaysian CPG 2011

SCREENING AND IN*ES+IGA+IO NS ,OR CKD IN PA+IEN+S -I+H DIABE+ES

Annual sceenin! "o #a$ien$s %i$& dia'e$es (elli$us and)o &y#e$ension

SCREENING AND IN*ES+IGA+IONS ,OR CKD IN PA+IEN+S -I+HO.+ DIABE+ES

Screening of general  population is not costeective. It is only done for people with high risks for developing CKD.

+REA+ MEN+ ,OR CKD

 Any class of antihypertensive agents can be used to treat hypertension in CKD patients without proteinuria. he choice will depend on the  patient!s co-"orbidity   AC#i$A%& should be used as 'rst-line agent in (on-diabetic CKD with urinary protein e)cretion *+.,g$d in the presence of hypertension (on-diabetic CKD when urinary protein e)cretion *.+g$d irrespective of  presence of hypertension  All diabetes patients with albu"inuria "icro- or •

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%enal pro'le should be carefully "onitored

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PRO+EIN.RIA Micoal'u(inuia

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.inay al'u(in e/ce$ion a$e 20  200(c!)(in)2& o 0300(!)2& Canno$ 'e de$ec$ed %i$& usual uine di#s$ic4 Ealies$ si!n o" dia'e$ic 4idney disease

Macoal'u(inuia a4a o5e$ #o$einuia

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.inay al'u(in e/ce$ion a$e 6200(c!)(in)2& o 600(!)2&

Po$einuia is an inde#enden$ #edic$o "o enal disease #o!ession

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 +&e (a!ni$ude o" 'aseline #o$einuia &as a linea ela$ions&i# %i$& #o!ession o" CKD and is4 o" C* e5en$s

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HAEMA+.RIA May indica$e in"ec$ion7 enal calculi7 #i(ay !lo(eulone#&i$is7 (ali!nancy

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Isola$ed non35isi'le &ae(a$uia is associa$ed %i$& a (odes$ inceased is4 o" #o!essi5e 4idney disease

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Posi$i5e di#s$ic4 $es$ 819 o (oe: "o 'lood on 2 ou$ o"  occasions (ay %aan$ a (icosco#ic e/a(ina$ion

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Pesence o" dys(o#&ic ed 'lood cells and ed cell cas$s indica$e !lo(eula disease

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RENA; ,.NC+ION •

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Renal "unc$ion s&ould 'e assessed %i$& MDRD eG,R< Seu( cea$inine s&ould 'e used in co('ina$ion %i$& eG,R in assess(en$ o" enal "unc$ion< -&en eG,R is no$ a5aila'le7 o$&e (e$&ods o" es$i(a$ion (ay 'e used<

RENA; +RAC+ .;+RASO.ND Iden$i=es o's$uc$i5e uo#a$&y7 enal si>e and sy((e$y7 enal scain! and #olycys$ic disease

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S+AGING 8NK,3KDO?I: S$a!in! CKD is 'ased on G,R 8le5el o" 4idney "unc$ion:

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Pa$&olo!ical c&an!es 84idney da(a!e:

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Pesence o" a'no(ali$y "o a$ leas$  (on$&s

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Kidney da(a!e is de=ned as ei$&e Pesis$en$ (icoal'u(inuia

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Peisis$en$ #o$einuia

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Pesis$en$ &ae(a$uia

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Radiolo!ical e5idence o" s$uc$ual a'no(ali$ies o" 4idneys

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Bio#sy #o5en !lo(eulone#&i$is

A$ any s$a!e o" CKD7 #esence o" #o$einuia

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Is associa$ed %i$& dou'lin! o" C* is4 and (o$ali$y Pedic$s #o!ession and de5elo#(en$ o" ESR,

 +&e dia!nosis o" CKD in $&e eldely s&ould no$ solely ely on eG,R es$i(a$ion  +&e NK,3KDO?I classi=ca$ion (ay lead $o o5edia!nosis o" CKD #a$iculaly in $&e eldely Eldely #a$ien$s 86@0 yeas old: %i$& s$a'le s$a!e A o" 4idney disease ae no$ li4ely $o de5elo# CKD3ela$ed co(#lica$ions

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 +REA+MEN+ +ARGE+S  +a!e$ BP 10)0((H! 8SBP an!e 12031((H!:

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 +a!e$ BP 10)0((H! 8SBP an!e 120312((H!:

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In #a$ien$s %i$& #o$einuia 61!)d In #a$ien$s %i$& dia'e$ic 4idney disease

S$ic$ BP lo%ein! is 'e$$e "o enal disease and s$o4e educ$ion 'u$ %ose "o C*D ou$co(es

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Po$einuia s&ould 'e educed $o 1!)d "o non3dia'e$ic CKD and $o no(oal'u(inuia "o DKD i" can 'e sa"ely ac&ie5ed

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 +REA+MEN+ CHOICES ACEI AND ARB ACEi and ARB eno#o$ec$i5e 9 cadio#o$ec$i5e

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In #a$ien$s %i$& dia'e$es (elli$us %i$& 4idney disease7

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Ris4 o" ESR, educed 'y 0 %i$& ACEi and 22 %i$& ARB Po!ession o" (ico $o (acoal'u(inuia educed 'y F %i$& ACEi and F1 %i$& ARB<

In non3dia'e$ic CKD #a$ien$s7

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No si!ni=can$ is4 o" enal disease #o!ession i" #o$einuia 1!)d a$ any BP le5el Si!n=can$ is4 o" enal disease #o!ession i" #o$einuia 61!)d and SBP 610((H! No 'ene=$ o" ACEi use i" non3dia'e$ic CKD %i$& &y#e$ension and

ACEi)ARB s&ould 'e a5oided o used %i$& cau$ion in #a$ien$s %i$&

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Renal a$ey s$enosis Eldely Conco(i$an$ NSAIDs use Conco(i$an$ (edica$ions #edis#osin! $o &y#e4ale(ia 8e! 'e$a 'loc4es and aldos$eone an$a!onis$s: Hy#o#e"usion s$a$es 8e! con!es$i5e cadiac "ailue7 de&yda$ion and se#sis:

 +&ese #a$ien$s s&ould 'e (oni$oed (oe "euen$ly<

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 +REA+MEN+ CHOICES CCB AND AA Non&ydo#iidine CCB e! 5ea#a(il

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can 'e consideed in &y#e$ensi5e #a$ien$s %i$& #o$einuia ei$&e as an al$ena$i5e in #a$ien$s in$olean$)con$aindica$ed $o ACEi)ARB o in co('ina$ion %i$& ACEi)ARB "o addi$ional #o$einuia educ$ion

Aldos$eone an$a!onis$ e! s#ionolac$one

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Con$o5esial esul$s ;on!3$e( eec$s on enal ou$co(e7 (o$ali$y and sa"e$y no$ es$a'lis&ed

 +REA+MEN+ CHOICES O+HER DR.GS ON +RIA; Renin in&i'i$o e! Alis4ien

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;icensed as an$i&y#e$ensi5e a!en$ Reno#o$ec$ion eec$ no$ es$a'lis&ed

Miscellaneous a!en$ e! Sulode/ide

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No$ #o5en eec$i5e an$i#o$einuia

OP+IMA; CON+RO; RENA; ,.NC+ION Reassess enal #o=le %i$&in 2 %ee4s o" s$a$in!)inceasin! ACEi)ARB

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I" $&ee is

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a sus$ained ise in cea$inine le5els 60 o eG,R educes 62F "o( $&e 'aseline o seu( #o$assiu( 6F