Un aggiornamento delle linee guida internazionali per la valutazione e la gestione della malattia renale cronica

AUTORI

ABSTRACT

An update of international guidelines for the evaluation and management of chronic kidney disease

An update of the 2002 guidelines for the evaluation and management of chronic kidney disease (CKD) has recently been published by the Kidney Disease Improving Global Outcomes (KDIGO) initiative. This report intends to summarize and comment the topics of interest for the clinical laboratory, emphasizing differences with the previous guideline. Clinical biochemists are explicitly mentioned among the target audience of new guidelines, because of the fundamental role that laboratory tests have in the detection and follow up of CKD; this is certainly something new in the history of clinical guidelines. The most important differences between 2002 and new guidelines are: a new risk prediction model including cause, glomerular filtration rate (GFR) and urine albumin results; a higher role assigned to urine albumin considered both as a component of risk prediction and as the primary test to detect proteinuria; the suggestion to use the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (considered more accurate than the Modification of Diet in Renal Disease (MDRD) formula) to calculate GFR; the utility of using cystatin C and the GFR formulas based on this protein to confirm the renal impairment in certain categories of patients. Laboratorians can find in the guidelines a number of detailed indications on how to report and interpret laboratory tests for CKD, ranging from the type of sample to be used for urine albumin measurement (i.e., the first morning void) to the way of estimated GFR reporting (rounded to the nearest whole number) and to creatinine and cystatin C calibration approaches that should be traceable to the international reference materials.

BIBLIOGRAFIA