accuracy of laboratory parameters in management of ckd
TRANSCRIPT
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Accuracy of Laboratory Parameters
in Management of CKD.
College of Medical Laboratory Science, Sri Lanka
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Direct Methods of
Nutritional Assessment
• Anthropometric methods
• Medical Laboratory methods
• Clinical methods
• Dietary evaluation methods
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CKD Risk Factors
Modifiable
• Diabetes
• Hypertension
• History of AKI
• Frequent NSAID use
Non-Modifiable
• Family history of kidney disease, diabetes, or hypertension
• Age 60 or older (GFR declines normally with age)
• Race/U.S. ethnic minority status
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Types of Assays
• Static assays: measures the actual level of
the component in the specimen (serum
iron, Serum electrolytes)
• Functional Assays: measure a
biochemical or physiological activity that
depends on the component of interest (eg:
Glycated haemoglobin, Creatinine)
• Functional assays are not always specific
to the component
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Target
• Accuracy
• Precision
• Accuracy
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• Detect renal
damage
• Monitor functional
damage
• Help determine
etiology
Categories of renal function tests
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• glomerular filtration
rate=GFR
• plasma creatinine= Pcr
• plasma urea-Purea
• urine volume= V
• urine urea- Uurea
• cystatin C in plasma?
• urine protein
• urine glucose
• hematuria
• Osmolality
• Electrolytes
Tests of renal function
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Tests of Glomerular Filtration Rate
• Urea
• Creatinine
• Creatinine Clearance
• eGFR
• Cystatin C
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GFR & Creatinine
• Ideal Marker
• Produced normally by the body
• Produced at a constant rate
• Filtered across glomerular membrane
• Removed from the body only by the
kidney filtered only, not reabsorbed or
secreted
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Interference
• Pre Analytical phase
• Analytical Phase
• Post Analytical Phase
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Interfering factors for elevated S. Creatinine
• Destruction of muscle
• High dietary intake of meat
• Hypothyroidism
• higher average muscle mass (Eg Afro-Caribbean)
• increase in musculature (Eg. Bodybuilding
• Drugs
• Some Cephalosporins
Interference with alkaline picrate assay
• Corticosteroids and vitamin D metabolites
Modify the production rate & the release of creatinine
• Artifactual (Eg. Diabetic Ketoacidosis) CMLS.SL 11
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Interfering factors for Reduced S. Creatinine
• Increasing age
Age-related decline in muscle mass
• Females - reduced muscle mass
• Malnutrition/ muscle wasting / amputation
Reduced muscle mass ± reduced protein intake
• Vegetarian diet
• Dehydration
• Hyperthyroidism
• Icteric Serum Specimens
Eg: Due to elevated Bilirubin
• Drugs - Testosterone therapy
Eg: Cimetidine, Trimethoprim, Sulphamethoxazole, Fibric acid D
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Patient Preparation for S. Creatinine
• No Specific patient preparation
• Dose adjustment or stop taking some interfering drugs on clinicians advice
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen
• Chemotherapy drugs
• Cephalosporin
• Cimetidine
• Interpret results with related to drug history
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Reference Range – S. Creatinine
Male
Infant - Not established
Age 1-2 years - 0.1–0.4 mg/dL
Age 3-4 years - 0.1–0.5 mg/dL
Age 5-9 years - 0.2-0.6 mg/dL
Age 10-11 years - 0.3-0.7 mg/dL
Age 12-13 years - 0.4-0.8 mg/dL
Age 14-15 years - 0.5-0.9 mg/dL
Age 16 years or older - 0.8-1.3 mg/dL
Female
Infant - Not established
Age 1-3 years - 0.1–0.4 mg/dL
Age 4-5 years - 0.2–0.5 mg/dL
Age 6-8 years - 0.3-0.6 mg/dL
Age 9-15 years - 0.4-0.7 mg/dL
Age 16 years or older - 0.6-1.1 mg/dL
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Serum Creatinine Concentration
• Normally 0.7-1.4 mg/dl, depending on
muscle mass
• Inversely proportional to GFR
• Good way to follow changes in GFR
• BUT also elevated by muscle mass,
tubular secretion
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Tests that predict kidney disease
• eGFR
• Albumin Creatinine Ratio
(ACR or Microalbumin)
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Kidney
damage and normal or GFR
Kidney
damage and
mild
GFR
Severe
GFR
Kidney
failure
Moderate
GFR
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Nephrologist Primary Care Practitioner
GFR 90 60 30 15
Who Should be Involved in the Patient Safety Approach to CKD?
Patient safety
Consult?
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Alternatives of identifying
CKD Stage 1
• Higher than normal levels of creatinine or urea
in the blood
• Blood or protein in the urine
• Evidence of kidney damage in an MRI, CT
scan, ultrasound or contrast X-ray
• A family history of polycystic kidney disease
(PKD)
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Assessment of component of interest
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Patients
Client
Healthy
Risk Group
Patient
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Diversity of Health Care Receivers
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Clinicians
Lab Professionals
Clinicians
Nutritionists
Clinicians
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Traditional Health care Flow
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Clinicians
Lab Professionals
Nutritionist
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Model for CKD/NCD control
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Co-Management Model
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Future Approach
• Can serum creatinine be made more
sensitive by adding more information?
• Does it required an easy test to screen risk
group in GFR that can apply at risk
populations
• Can we assure patient centered health care
service with novel collaborative co
management model
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Thank you
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