Existing chemical panels already include numerical indices for chronic renal disease, a reader says.
The new American College of Physicians guidelines against screening for chronic renal disease (“Recommendations on the screening, monitoring, and treatment of early-stage chronic kidney disease,” April 10, 2014) are really a moot point since every chemistry panel has three numerical indices for this very disease.
For the last five or six years, every laboratory in the U.S. includes: BUN (blood urea nitrogen), creatinine, and eGFR (Glomular Filtration Rate). The estimated GFR is even broken down for African-American patients and non-African-Americans. Therefore, when a patient receives a printout of his/her blood chemistries, implied is the actual stage of renal function and/or diseases.
“…false positives, unnecessary treatment and added healthcare costs” are now built into the system. I myself had three different chemistry panels done last summer at three different labs and my eGFR differed by 13 points!
Of course, those with long-standing hypertension, diabetes, obesity and other single- or multiple-risk factors can often be motivated into treatment and lifestyle modifications by these numbers. Others become quite concerned and I often have to perform a renal ultrasound to make sure the patient has two functioning kidneys. Some, with eGFR in the 50 point range do in fact have only one functioning kidney. Others are reassured that they have normal anatomy. Either way, often a follow-up evaluation is necessary to the data found on a routine chemistry panel.
Arnold Chanin, MD
El Segundo, California