The Laboratory’s Expanded Role in Managing Kidney Disease
disease is one of the most significant chronic ailments affecting Americans. Renal
disease is often a sequela of one of several maladies that plague Americans:
diabetes, hypertension, glomerulonephritis, autoimmune disease, polycystic
kidney disease and others.
estimated 20 million Americans have chronic kidney disease (CKD) some managed by
diet, exercise and medication alone, while others need regular dialysis.
of life can be adversely affected and impacted by kidney disease.
laboratory plays a crucial role in the diagnosis and treatment of renal
disease. One of the ongoing challenges for providers is the variation in tests
performed by different laboratories on different platforms using different
reagents. There have been several
attempts to create harmonization to standardize results and make it easier to
interpret results from various labs and even from visit to visit.
late 2012 some guidelines called the Kidney Disease Improving Global Outcomes
(KDIGO) Clinical Practice Guidelines for the Evaluation and Management of CKD
guidelines were developed through the collaboration of many international experts
and build significantly on lessons learned from previous guidelines. One very important
aspect of this guideline is that it contains strong recommendations for
laboratory input and involvement in the process of care. It only makes sense
that the experts who provide the information used in decision making should
understand the recommended best practices and the rationale for such practices.
surprisingly, laboratory involvement will require a more active participation,
rather than the typical passive behind the scenes “just do what the doctor orders”
the “Key Factors for Laboratorians” required by the 2012 KDIGO Guideline are the
good communication between laboratory professionals and relevant clinicians,
such as nephrologists and primary care doctors.
for common laboratory practices in a region so patients receive the same care
with comparable results from visit to visit, regardless of location where the testing is performed.
creatinine results are aligned to an isotope dilution mass spectrometry
an appropriate glomerular filtration Rate (GFR) formula for your population.
should use the same units, number of significant figures and clinical decision
points for both serum creatinine and eGFR reporting.
should understand, and provide information on, their creatinine method, including
any limitations and interpretation
should provide measurements of urine albumin and urine creatinine using traceable
assays. These tests might be part of a periodic monitoring protocol in a high-risk
population such as known diabetics.
should provide Albumin/Creatinine ratio (ACR) and do so in a clear, consistent
manner to help clinicians make correct decisions regarding declining renal
function in any one patient from site to site and visit to visit.
of these recommendations make good sense and offer yet another chance for the laboratory
to be an active participant in patient care. This involvement should provide
job enrichment as the laboratorian assumes a greater proactive and professional role. However,
these are recommendations, not mandates.
If laboratorians are hesitant and acquiescent then
another player will step forward. Then once again, someone outside the laboratory, perhaps
with limited knowledge of MLS, will direct “the lab” on what to do. It’s our