Kidney Disease—To Screen or Not to Screen?

UrineSampleA new guideline just issued from the American College of Physicians (ACP) discourages routine testing for kidney disease. If you saw the headlines and were wondering how that fits with the National Kidney Foundation’s (NKF) recommendations, read carefully and you’ll see we’re all on the same page, at least on that point. Sometimes it’s just a matter of wording. NKF has always recommended routine testing for kidney disease for everyone over 60 as well as those with diabetes, high blood pressure and a family history of kidney failure. In other words, we urge those with major risk factors to get screened with blood and urine tests. The ACP’s guideline cautions against screening for people with no symptoms and no risk factors.

The ACP’s new guideline goes further and advises against testing for high levels of protein in the urine in people with or without diabetes who are taking certain heart drugs, such as an ACE inhibitor or an ARB. And here is where the ACP and the NKF differ.

The NKF, as well as the international guideline group, Kidney Disease Improving Global Outcomes (KDIGO), recommends monitoring of protein in the urine (one of the very earliest signs of kidney damage) at least annually in those with major risk factors such as diabetes and this is even if they are taking a blood pressure drug. We believe that whether or how often someone gets monitored for protein in the urine should be determined by their medical history and other risk factors.

Why’s that? Because if high levels of protein in the urine are present, people are more likely to progress to kidney failure if they are not treated appropriately. And if your doctor’s not monitoring, he or she won’t have all the information needed to be sure you are getting the best treatment.

Bottom Line: If you don’t have major risk factors (high blood pressure, diabetes, family history, age over 60), you don’t need to get tested for kidney disease. If you do have diabetes, NKF says you should ask your doctor to check for protein in the urine, even if you are taking a blood pressure drug.

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