The Patient with Chronic Kidney Disease: What the MA Should Know


Article Categories: Patient Care & Laboratory and Testing

Kidney disease is one of the common serious conditions that Medical Assistants will see every day. When it develops gradually, it’s known as Chronic Kidney Disease (CKD) and can cause many complications, such as:

• anemia
• osteoporosis
• impaired nutrition
• nerve damage
• kidney failure



One of the interesting things about CKD is that it’s both caused by hypertension and causes hypertension. The resulting heart disease is the leading cause of death for people with CKD. Diabetes is the second main cause of CKD; uncontrolled glucose levels lead to damage in many organs, including the kidneys and the vessels that supply blood and oxygen to them.

Who’s at risk for CKD? The same groups that are already at risk for diabetes and hypertension: older people of all cultures, African Americans, Hispanic, Asian, Pacific Islanders, and American Indians. While CKD can develop at any age, especially with a family history, Medical Assistants should focus on patients in the high-risk groups.

Kidney disease may go undiagnosed for many years. When assessing patients, pay attention to the following complaints, which are signs of CKD:

• Fatigue and reduced energy
• Difficulty concentrating
• Poor appetite and weight loss
• Edema in feet and ankles
• Puffiness in the face, especially in the morning
• Trouble sleeping
• Dry, itchy skin

CKD is diagnosed by monitoring the patient’s blood pressure and lab results:

1. Glomerular Filtration Rate (GFR): The best estimate of kidney function, the GFR can be estimated from the creatinine level, age, race, gender, and several other indicators. Normal values are 90-120mL/min. If values are < 60mL/min, some kidney damage has occurred. If the GFR falls below 30mL/min, the patient is referred to a nephrologist. A GFR below 15mL/min requires dialysis or kidney transplant.

2. Creatinine: The results of a serum creatinine test indicate how well the kidneys are filtering the waste products of muscle activity. Normal levels for women are 0.6-1.1mg/dL and 0.7-1.3mg/dL for men. It can rise with dehydration, weight training, or increased protein intake, but if it remains elevated, there is likely kidney impairment. Patients usually begin dialysis if the creatinine level reaches 10mg/dL.

3. Urine Protein: When the kidneys can’t filter protein, it spills into the urine. A simple urine dipstick can determine the presence of protein, an early sign of CKD. A result of 1+ or greater requires a second albumin-specific dipstick test. If proteinuria persists, a 24-hour urine collection may be ordered for a complete analysis.

As a valuable member of the healthcare team, the Medical Assistant is in the ideal position to help with initial screening, by simply assessing three factors:

1. Is there diabetes or blood sugar problems?
2. Is there high blood pressure?
3. Is there a family history of kidney disease?

“Most people know nothing about kidney disease--until it’s too late,” says Andrew Narva, MD, Director of the National Kidney Disease Education Program, part of the National Institute of Health. “The good news is that kidney disease can be effectively treated in the early stages.”

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