Chronic Kidney Disease (CKD)

Definition of CKD:

• GFR <60 mL/min/1.73m² for >3 months

• GFR >60 mL/min/1.73m² and evidence of structural damage or other markers of kidney damage

  • Abnormal imaging (including transplanted kidney)

  • Proteinuria/albuminuria

  • Urine sediment abnormalities:

    • Microscopic hematuria with dysmorphic RBCs (GBM disorders)

    • RBC casts (proliferative glomerulonephritis)

    • WBC casts (pyelonephritis, interstitial nephritis)

    • Oval fat bodies or fatty casts (diseases with proteinuria)

    • Granular casts and renal tubular epithelial cells (nonspecific markers of parenchymal disease)

  • Structural abnormalities detected by imaging

  • History of kidney transplantation

  • Renal tubular disorders

• Once a patient is determined to have CKD using the above criteria, they can be stratified as follows:

  • G1 – Normal GFR (≥90 mL/min per 1.73 m2)

  • G2 – GFR between 60 and 89 mL/min per 1.73 m2

  • G3a – GFR between 45 and 59 mL/min per 1.73 m2

  • G3b – GFR between 30 and 44 mL/min per 1.73m2

  • G4 – GFR between 15 and 29 mL/min per 1.73 m2

  • G5 – GFR of <15 mL/min per 1.73 m2

• Estimation of GFR is typically based on serum creatinine

  • If you have Cystatin C, you will also need a serum creatinine level (ideally from same draw) for CKiD U25 estimation of GFR (http://gfr.kidney.wiki)

• For ESKD patients, this comes with a description of UOP as well (anuric, oliguric, non-oliguric)

• All CKD kids immunizations should be up to date, including annual flu vaccine

• HD and PD kids will get periodic Hep B sAb checked to check their immune status. 

  • If undetectable, they will go to PCP to get a booster and levels will be rechecked in a few weeks

  • If still undetectable, they are sent back to PCP to repeat full 3-shot series

• All HD and PD kids must have documented Hep B sAg (antigen) at the start of their HD treatments with us (just once is fine). This is important for the inpatients who get started urgently. Be sure to order the Hep B sAg during their inpatient stay.