We typically categorise chronic kidney disease according to how low the EGFR is. It obviously depends on the magnitude of the decrease. Once a low EFGR has been detected, what is the next step? Other deeper investigations can then be carried out to find out whether the high levels of creatinine truly indicate a decreased kidney function, and patients should discuss what these may be with an experienced nephrologist. It is usually detected on a routine blood test, that is often carried out for a different reason altogether. It can be very serious, especially if the EFFR levels are very low, as this indicates a very low kidney function. Might it indicate a potentially severe condition? Inflammatory conditions such as lupus, and structural problems with the kidneys, such as polycystic kidney disease, can also cause a reduced kidney function. If one’s low EGFR is kidney-related, the most common causes for this typically include hypertension, diabetes, and other conditions that can cause vascular disease. If the EGFR is very low, then this suggests that kidney function is very low, which is very serious. There are other causes of a low EGFR, such as increased muscle bulk and increased muscle turnover. If your EGFR is low, then the suspicion is you may have a kidney problem. The estimate of kidney function is based on the creatinine level in the blood. So, here, we are talking about an estimate of someone’s kidney function on a blood test. What does a low EGFR mean in a typical blood test?ĮGFR simply refers to estimated glomerular filtration rate. See NICE's guideline on renal replacement therapy and conservative management.Ĭonservative management and when it may be considered.In our latest article, we speak to revered London-based consultant nephrologist, Dr David Game, to find out what a low EGFR indicates in a typical blood test, and whether or not a low EGFR may indicate a more severe medical condition. Information about renal replacement therapy (such as the frequency and length of time of dialysis treatment sessions or exchanges and pre-emptive transplantation) and the preparation needed (such as having a fistula or peritoneal catheter), if appropriate for the person. How can people cope with and adjust to CKD and what sources of psychological support are available? In what ways could CKD and its treatment affect people's daily life, social activities, work opportunities and financial situation, including benefits and allowances available? What can people do to manage and influence their own condition? What treatments are available for CKD, what are their advantages and disadvantages, and what complications or side effects may occur as a result of treatment or medication? What questions should people ask about their kidneys? What is CKD and how does it affect people? GFR category G5: kidney failure (under 15 ml/min/1.73 m 2)Īdapted with permission from the KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Ībbreviations: ACR, albumin creatinine ratio CKD, chronic kidney disease GFR, glomerular filtration rate. GFR category G4: severe reduction (15 to 29 ml/min/1.73 m 2) GFR category G3b: moderate to severe reduction (30 to 44 ml/min/1.73 m 2) GFR category G3a: mild to moderate reduction (45 to 59 ml/min/1.73 m 2) GFR category G2: mild reduction related to normal range for a young adult (60 to 89 ml/min/1.73 m 2) No CKD if there are no other markers of kidney damage GFR category G1: normal and high (90 ml/min/1.73 m 2 or over) Table 1 Risk of adverse outcomes in adults by GFR and ACR categoryĪCR category A1: normal to mildly increased (less than 3 mg/mmol)ĪCR category A2: moderately increased (3 to 30 mg/mmol)ĪCR category A3: severely increased (over 30 mg/mmol) When a recommendation refers to 'people', this means adults, children and young people. But for brevity, we have used 'people' for later recommendations. When recommendations apply to adults, children and young people we have specified this in recommendations at the beginning of a section. When a recommendation applies to children and young people only, we have also specified this in the recommendation. Some recommendations in this guideline apply to adults only, and we have specified 'adults' in these individual recommendations. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
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