Persistent proteinuria indicates the presence of CKD
+ Semequantitative methods of urine protein excretion, such as the spot urine albumin/creatinin ratio, are recommended for determining the severity of CKD and monitoring the rate of disease progression
(30-300mg albumin / 1g creatinin considered to be in the microalbuminuria range)the 24-hour urine collection is being replaced by a similarly accurate but less cumbersome ration of protein or albumin to creatinin obtained from an untimed (spot) urine specimen.
+ MDRD equation and GFR
+ ACEIs and angiotensin receptor blockers are intended to slow the progression of kidney disease.
+ Hypertensin and Algorithm.
Thiazide diuretics given once daily are recommended in patients with GFR ≥30 mL/min/1.73 m2 (CKD Stages 1-3) (A);
Loop diuretics given once or twice daily are recommended in patients with GFR <30 mL/min/1.73 m2 (CKD Stages 4-5) (A);
Loop diuretics given once or twice daily, in combination with thiazide diuretics, can be used for patients with ECF volume expansion and edema (A).
12.1.d Potassium-sparing diuretics should be used with caution:
12.1.d.i In patients with GFR <30 mL/min/1.73 m2 (CKD Stages 4-5) (A);
12.1.d.ii In patients receiving concomitant therapy with ACE inhibitors or ARBs (A);
12.1.d.iii In patients with additional risk factors for hyperkalemia (A).
12.2 Patients treated with diuretics should be monitored for:
12.2.a Volume depletion, manifest by hypotension or decreased GFR (A);
12.2.b Hypokalemia and other electrolyte abnormalities (A).
12.2.c The interval for monitoring depends on baseline values for blood pressure, GFR and serum potassium concentration
