Approach to Renal Disorders

Posted by e-Medical PPT
To identify appropriate strategies for investigation of the patient with kidney disease
To discuss interventions that may alter the course of disease
To discuss indications for referral to a nephrologist

Elevated Serum creatinine: recommendations for management and referral.  CMAJ 1999: 161:413-17
National Kidney Foundation: Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), 2002
Practice guidelines for Chronic Kidney Disease.  2003.  Annals of Internal medicine. Vol. 139 Number 2.

Workup of a decreased GFR
1. Identify chronicity (Acute vs chronic)
2. Identify the cause, especially reversible causes
3. Identify Indications for Referral to a Nephrologist
4. Initiate a cause specific management plan in a multidisciplinary team.

Normal size kidneys in chronic kidney disease
Polycystic kidney disease
Myeloma Kidney
HIV Nephropathy

Renal Biopsy
Should be considered:
If noninvasive tests have failed to establish a diagnosis in a patient with:
Nephrotic syndrome (except in DM or established amyloid)
Non-nephrotic proteinuria if associated with renal dysfunction
Lupus nephritis (for dx and staging)
Acute nephritic syndrome   
Unexplained acute/ subacute renal failure
To direct and evaluate effectiveness of therapy

Management of Renal Disease
Treatment of Reversible Causes
Preventing or Slowing Progression
Treating and Preventing the Complications
Identifying Individuals Requiring Renal Replacement Therapy

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