Assessment and management of Stage 3 CKD.

I think Stage 3 CKD is the most important stage of kidney disease,If you are in this stage, you should treat as soon as possible, because if the disease from getting worse, then the difficulty of treatment is that you can not imagine,the following article can tell you how to assessment you are in what stage of ckd.

In Stage 3 CKD eGFR is approximately 30-60%: eGFR 45-59 (3A) or 30-44 (3B). Rememember that eGFR is an estimate (more info on eGFR) and may require a correction for (black) race.
Creatinine and eGFR in an individual are usually quite stable. Deteriorating renal function needs rapid assessment. Note that CKD staging and management outlined below are only applicable to stable renal function.

Assessment and management of Stage 3 CKD.

Most Stage 3 CKD can be appropriately managed in primary care. The aim is to identify individuals at risk of progressive renal disease, and reduce associated risks.
Risk of cardiovascular events and death is substantially increased by the presence of CKD. The risk of cardiovascular death is (on average) much higher than the risk of needing dialysis or a renal transplant.
Some patients need further investigation where there are indications that progression to end stage renal failure (Stage 5) may be likely. Pointers to progression of renal disease are:
Proteinuria - the risk is graded, but a common cut-off for investigation is ACR>70 or PCR>100
Haematuria of renal origin
Declining GFR
Young age
Long term monitoring of renal function and other parameters is indicated.
Initial assessment | Management

Initial assessment of stage 3 CKD

The aim is to identify individuals at risk of progressive renal disease, and to reduce associated risks.
Is the patient well? Is there a histor of significant associated disease? Consider referral if systemic disease process involving kidneys supported by urinary abnormalities or other indicators.
If assessment is precipitated by a first discovery of elevated creatinine, it is important to be certain that the value is stable. Maybe there are previously recorded values? If not, and the patient is well, repeat test within 14 days. Ideally this sample should be taken after a period of at least 12h without meat consumption, and the sample must get to the lab or be separated the same day. Deteriorating renal function needs rapid assessment.
Clinical assessment - especially for sepsis, heart failure, hypovolaemia, examination for bladder enlargement (imaging indicated if obstruction suspected from symptoms or examination).
Medication review - any potentially nephrotoxic drugs, or drugs that need dose alterations when GFR reduced?
Urine tests: dipstick for blood and quantitation of proteinuria by ACR/PCR. Presence of haematuria or proteinuria may suggest progressive renal disease.
Imaging - exclusion of obstruction is indicated in patients with singnificant urinary symptoms or other things to suggest obstruction.
See referral by urgency

Management of Stage 3 CKD

6 then 12 monthly estimation of
Creatinine and K - consider an unxexplained fall in eGFR of >25% to be acute renal failure. NICE suggest seeking specialist advice for a loss in GFR over 1y of 5ml/min, or a loss of GFR in 5y of 10ml/min. More on deteriorating function
Hb - if low, exclude non-renal cause. Below 110 g/l, specific therapy may be considered. Hb falls progressively as GFR falls, but renal anaemia rarely becomes significant before stage 3B or 4 CKD. More on anaemia
Urinar y protein for ACR or PCR. Note thresholds; ACR 30 or PCR 50 for more stringent blood pressure targets (and suffix 'p' on CKD stage), and ACR 70 or PCR 100 for specialist referral/discussion. More on proteinuria
Blood pressure - 140/90 max (130-139/90), or 130/80 max (120-129/80) for patients with proteinuria: urinary ACR>30 or PCR>50. More on hypertension
Cardiovascular risk - advice on smoking, exercise and lifestyle. Consider cholesterol lowering therapy if already have macrovascular disease, or if estimated 10 year risk of cardiovascular events =/>20%. More on CV risk in CKD
Immunization - influenza and pneumococcal
Medication review - regular review of medication to minimise nephrotoxic drugs (particularly NSAIDs) and ensure doses of others are appropriate to renal function.
About CKD stagesGFR>60
Stages 1+2 CKDGFR 30-59
Stage 3 CKDGFR<30
Stages 4+5 CKD

Patient info - Stage 3 CKD

Most patients with Stage 3 CKD are older, and only a minority go on to get more serious kidney disease. Their increased rate of cardiovascular disease (heart attacks, strokes, narrowing of other arteries) is very important. However some do go on to get severe kidney failure, and there are some pointers that make this seem more likely.

During this period, we must find a suitable therapy，I hope this website can give you some advice.
http://www.kidneyhospitalchina.org/treatments/
If you want to know more information about these therapy you can send me an email
kidney.hospital.china@gmail.com