Abnormal Renal Lab Values

stampinsavage@gmail.com

I have a simple question in regard to 2 abnormal Creatinine levels. There is no mention of CKD at all. There were only 2 Gen. Chemistry panels drawn on a 7 day stay. I typically don't like to query with only 2 values. They are fairly close results and the GFR is indicative of CKD 3. I am curious what the general consensus is: query with 2 values, or with 3? 

lprescott1

I would use caution querying for CKD staging based on 2 values over a seven day stage. For example, if the patient's eGFR was low on admission due to dehydration it cant actually support CKD staging. Data needed to stage CKD must be trended over three months.  So the first question is was there any acute issue that might have affected the reported eGFRs for the stay, if so then the values you have are not enough to support staging. Are there other factors present to support chronic kidney disease? The article below might assist with criteria used to query for CKD staging. 

https://renal.org/information-resources/the-uk-eckd-guide/ckd-stages/

stampinsavage@gmail.com

The values were very consistent between the 2 of them. I don't like to query with just 2 values but we are expected/asked to do so. I appreciate the link and will do some more investigation. I do give the option of "unable to clinically determine". Thank you for your response @lprescott1

afrady@blr.com

It sounds to me (just guessing here) that the previous CKD was probably established, the physician knew it but never documented it.   Under this scenario the MD would have largely ignored the two lab values if they were in line with what he/she expected.  This at least, could explain the lack of documentation, testing, evaluation or referral.

 The Less likely scenario would require the physician to have completely ignored two very abnormal lab values in a patient with previously healthy kidneys and I find that scenario abit more frightening than the former. 

A third scenario is that the abnormal values were expected and integral to some other disease process or treatment regimen which is also less likely but would require a full record review to comment on.

stampinsavage@gmail.com

Thanks for the comment @afrady@blr.com. There had not been any documentation of prior CKD in the PMHX. It would be a new finding. With only 2 abnormal values, which were both "tight" with CKD 3 GFR values, I would suspect CKD. BUN was WNL's. Unfortunately, without documentation of abnormal creatinine in the med record, it's difficult to query, other that to say "during the course of routine chart review, some abnormal renal lab values were noted" as a segue into the query. I like to have a 3rd value to query for renal, unless the Provider documents "Chronic Renal Failure/Chronic Kidney Disease". I was looking for a general consensus.  I did not place a query.