chronic kidney disease malaysian cpg 2011

8/17/2019 Chronic Kidney Disease Malaysian CPG 2011

1/22

CHRONIC KIDNEY

DISEASE

Based on2011


2/22

Annual sceenin! "o #a%i$& dia'e$es (elli$us a&y#e$ensionSCREENING

ANDIN*ES+IGA+IO

NS ,OR CKD INPA+IEN+S -I+HDIABE+ES


3/22

Screeni populateectivfor peoprisks fo

CKD.

SCREENING ANDIN*ES+IGA+IONS,OR CKD INPA+IEN+S-I+HO.+DIABE+ES


4/22

Any class of anagents can be hypertension iwithout proteinchoice will dep

patient!s co-"

AC#i$A%& shou'rst-line agent• (on-diabetic

urinary prote*+.,g$d in th

hypertension• (on-diabetic

urinary prote*.+g$d irre

presence of • All diabetes

albu"inuria

"acroalbu"irres ective

%enal pro'leshould becarefully"onitoredfollowing

+REA+MEN+

,ORCKD


5/22


6/22

PRO+EIN.RIA

•Micoal'u(inuia• .inay al'u(in e/ce$ion a$e 20 200(c!)(in)2& o 0300(!

• Canno$ 'e de$ec$ed %i$& usual uine di#s$ic4

• Ealies$ si!n o" dia'e$ic 4idney disease

•Macoal'u(inuia a4a o5e$ #o$einuia• .inay al'u(in e/ce$ion a$e 6200(c!)(in)2& o 600(!)2&

•Po$einuia is an inde#enden$ #edic$o "o enal disease#o!ession

• +&e (a!ni$ude o" 'aseline #o$einuia &as a linea

ela$ions&i# %i$& #o!ession o" CKD and is4 o" C* e5en


7/22


8/22

HAEMA+.RIA

•May indica$e in"ec$ion7 enal calculi7 #i(ay!lo(eulone#&i$is7 (ali!nancy

•Isola$ed non35isi'le &ae(a$uia is associa$ed %i$& a (odinceased is4 o" #o!essi5e 4idney disease

•

Posi$i5e di#s$ic4 $es$ 819 o (oe: "o 'lood on 2 ou$ o" occasions (ay %aan$ a (icosco#ic e/a(ina$ion

•Pesence o" dys(o#&ic ed 'lood cells and ed cell cas$indica$e !lo(eula disease


9/22

RENA; ,.NC+ION

• Renal "unc$ion s&ould 'eassessed %i$& MDRD eG,R<

• Seu( cea$inine s&ould 'e usedin co('ina$ion %i$& eG,R inassess(en$ o" enal "unc$ion<

• -&en eG,R is no$ a5aila'le7 o$&e(e$&ods o" es$i(a$ion (ay 'eused<


10/22

RENA; +RAC+ .;+RASO.N

•Iden$i=es o's$uc$i5e uo#a$&y7 enal si>e and sy((e$yenal scain! and #olycys$ic disease


11/22

S+AGING 8NK,3KDO?I:

S$a!in! CKD is 'ased on•G,R 8le5el o" 4idney "unc$io

•Pa$&olo!ical c&an!es 84idn

•Pesence o" a'no(ali$y "o(on$&s

Kidney da(a!e is de=ned a•Pesis$en$ (icoal'u(inui

•Peisis$en$ #o$einuia

•Pesis$en$ &ae(a$uia

•Radiolo!ical e5idence o" s$a'no(ali$ies o" 4idneys

•

Bio#sy #o5en !lo(eulone


12/22

•A$ any s$a!e o" CKD7 #esence o" #o$einuia• Is associa$ed %i$& dou'lin! o" C* is4 and (o$ali$y

• Pedic$s #o!ession and de5elo#(en$ o" ESR,

• +&e dia!nosis o" CKD in $&e eldely s&ould no$ solely ely on eG,R

es$i(a$ion• +&e NK,3KDO?I classi=ca$ion (ay lead $o o5edia!nosis o" CKD#a$iculaly in $&e eldely

• Eldely #a$ien$s 86@0 yeas old: %i$& s$a'le s$a!e A o" 4idney disae no$ li4ely $o de5elo# CKD3ela$ed co(#lica$ions


13/22

+REA+MEN+ +ARGE+S

• +a!e$ BP 10)0((H! 8SBP an!e 12031((H!:

• +a!e$ BP 10)0((H! 8SBP an!e 120312((H!:• In #a$ien$s %i$& #o$einuia 61!)d

• In #a$ien$s %i$& dia'e$ic 4idney disease

•

S$ic$ BP lo%ein! is 'e$$e "o enal disease and s$o4eeduc$ion 'u$ %ose "o C*D ou$co(es

•Po$einuia s&ould 'e educed $o 1!)d "o non3dia'e$ic and $o no(oal'u(inuia "o DKD i" can 'e sa"ely ac&ie5


14/22

+REA+MEN+ CHOICES ACEAND ARB•ACEi and ARB eno#o$ec$i5e 9 cadio#o$ec$i5e

•In #a$ien$s %i$& dia'e$es (elli$us %i$& 4idney disease7• Ris4 o" ESR, educed 'y 0 %i$& ACEi and 22 %i$& ARB

• Po!ession o" (ico $o (acoal'u(inuia educed 'y F %i$& AF1 %i$& ARB<

•In non3dia'e$ic CKD #a$ien$s7• No si!ni=can$ is4 o" enal disease #o!ession i" #o$einuia 1!)dany BP le5el

• Si!n=can$ is4 o" enal disease #o!ession i" #o$einuia 61!)d an610((H!

• No 'ene=$ o" ACEi use i" non3dia'e$ic CKD %i$& &y#e$ension and

#o$einuia 0


15/22

•ACEi)ARB s&ould 'e a5oided o used %i$& cau$ion in #a$%i$&• Renal a$ey s$enosis

• Eldely

• Conco(i$an$ NSAIDs use

•

Conco(i$an$ (edica$ions #edis#osin! $o &y#e4ale(ia 8e! 'e$a'loc4es and aldos$eone an$a!onis$s:

• Hy#o#e"usion s$a$es 8e! con!es$i5e cadiac "ailue7 de&yda$ion se#sis:

• +&ese #a$ien$s s&ould 'e (oni$oed (oe "euen$ly<


16/22

+REA+MEN+ CHOICES CCBAND AA•Non&ydo#iidine CCB e! 5ea#a(il• can 'e consideed in &y#e$ensi5e #a$ien$s %i$& #o$einuia ei$&eal$ena$i5e in #a$ien$s in$olean$)con$aindica$ed $o ACEi)ARB o inco('ina$ion %i$& ACEi)ARB "o addi$ional #o$einuia educ$ion

•

Aldos$eone an$a!onis$ e! s#ionolac$one• Con$o5esial esul$s

• ;on!3$e( eec$s on enal ou$co(e7 (o$ali$y and sa"e$y no$ es$a


17/22

+REA+MEN+ CHOICESO+HER DR.GS ON +RIA;•Renin in&i'i$o e! Alis4ien• ;icensed as an$i&y#e$ensi5e a!en$

• Reno#o$ec$ion eec$ no$ es$a'lis&ed

•Miscellaneous a!en$ e! Sulode/ide• No$ #o5en eec$i5e an$i#o$einuia


18/22

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

•I" $&ee is• a sus$ained ise in cea$inine le5els 60 o

• eG,R educes 62F "o( $&e 'aseline o

• seu( #o$assiu( 6F


19/22

OP+IMA; CON+RO; HBA1CS+A+IN7 AN+IP;A+E;E+• +a!e$ H'A1c s&ould 'e @ in #a$ien$s %i$& dia'e$es< Ion andey$&o#oie$in can cause a si!ni=can$ "all in H'A1c 5alues %i$&oc&an!e $o !lycae(ic con$ol in #a$ien$ %i$& DM and CKD< Re!ulaca#illay !lucose (easue(en$s ae needed "o a (oe accua$eassess(en$ o" !lycae(ic con$ol<

•S$a$in s&ould 'e oeed $o #a$ien$s %i$& CKD "o #i(ay and

seconday #e5en$ion o" cadio5ascula e5en$s< +&ee is no e5ido" li#id lo%ein! in e$adin! $&e #o!ession o" CKD o educ$ion#o$einuia<

•As#iin s&ould 'e used in #a$ien$s %i$& CKD "o seconday #e5eo" cadio5ascula e5en$s< Co('ina$ion o" clo#ido!el and as#iins&ould 'e a5oided as $&ee is an incease in o5eall (o$ali$y 'y


20/22

DIE+

•;o% #o$ein die$ 80


21/22

PREGNANCY

•Pe!nancy (ay 'e consideed in %o(en %i$& CKD &a5in(ild enal i(#ai(en$ 8seu( cea$inine 12u(ol);: a%ell3con$olled 'lood #essue

•-o(en %i$& (odea$e $o se5ee enal i(#ai(en$ s&oucounselled $o a5oid #e!nancy due $o !ea$e ad5ese

(a$enal and "e$al ou$co(es•Me$&od o" con$ace#$ion used %ould de#end on $&eundelyin! cause o" enal disease and associa$ed co3(o'idi$ies


22/22

RE,ERRA;

I((edia$e e"eal is indica$ed in#a$ien$s %i$&• Acu$e enal "ailue su#ei(#osed

on CKD• Ne%ly de$ec$ed ESR, 8G,R

1F(l)(in)1

chronic kidney disease malaysian cpg 2011

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