Chronic kidney disease CKD is an unrecognized epidemic that has the potential to cause serious morbidity and mortality to thousands of British Columbians. It may also result in millions of dollars in new health care costs for a system already under strain. Chronic kidney disease is a prevalent problem that causes significant morbidity and mortality. Appropriate screening and early management can significantly improve outcomes.
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BC Guidelines are clinical practice guidelines and protocols that provide recommendations to B. Management of these conditions is beyond the scope of this guideline. However, in some cases, notes and alternatives to imaging are provided for additional clinical context.
Updates in the revised version include discussion on the optimal concentration of vitamin D levels, dietary and supplemental information on vitamin D and a brief discussion on the controversies of vitamin D and chronic illness.
The guideline scope includes diagnosis, investigation and management of iron deficiency in patients of all ages. It features a new algorithm for investigation of non-anemic iron deficiency in adults, a new appendix on pediatric iron doses and liquid formulations, updated medication tables, enhanced information on nutrition including vegetarian and vegan diets, and enhanced information on pediatrics.
Select Key Recommendations include see full recommendation list :. It is an updated version of the Testosterone Testing Protocol. Key changes include: recommendations that patients fast, use the same lab for initial and follow-up tests, and be tested when the sleep-wake cycle is stable. The protocol working group included representatives of family medicine, endocrinology, laboratory medicine, and pharmacy.
Key recommendations include:. Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder is a revision of the version of the guideline. The guideline scope has expanded to include pediatric and pregnant patients and a laboratory algorithm has also been added to the guideline. Key changes to note include:. BC Guidelines has partnered with Dr.
The free and redesigned mobile app works even without Internet connectivity so busy practitioners can instantly access BC Guidelines on any Apple or Android mobile device no matter where they are working. To get updates when new guidelines are developed or revised, sign up for our mailing list at:. BC physicians and health professionals are invited to act as peer reviewers for BC Guidelines.
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Urological System. BC Guidelines. About the Guidelines BC Guidelines are clinical practice guidelines and protocols that provide recommendations to B.
There are several ways to find the guidelines you are looking for. Browse the guidelines alphabetically or by topic area. Key recommendations include: Imaging is not recommended for uncomplicated headache unless red flags are present. CT head scans are not recommended in adults and children who have suffered minor head injuries unless positive for a head injury clinical decision rule. Chest CT for suspected pulmonary embolism is not recommended in low-risk patients with a normal D-dimer result.
Imaging is not recommended for low back pain unless red flags are present. MRIs of hip or knee joints are not recommended in patients with co-existent pain and moderate to severe osteoarthritis unless red flags are present.
Practitioners are encouraged to consult a radiologist if they have any concerns or questions regarding which imaging test is appropriate for a given problem. Confirm abnormal test results with a repeat measurement and obtain urinalysis Determine likely cause of kidney disease where possible. Key Recommendations include: Routine vitamin D testing or screening for vitamin D deficiency is not recommended.
Measurement of vitamin D levels is not generally required prior to or after initiating vitamin D supplementation. Vitamin D testing is indicated in patients who are at high risk for vitamin D deficiency such as those with malabsorption syndromes, renal failure, unexplained bone pain, unusual fractures, or other evidence of metabolic bone disorders.
New key recommendations include: Use a case-finding approach to identify individuals at risk of iron deficiency and iron deficiency anemia. There is no indication for population-based general screening. Determine the cause of iron deficiency. Consider age and clinical presentation when investigating for cause.
Iron deficiency by itself causes symptoms for patients, even in the absence of anemia, and warrants investigation and treatment. Ferritin is the test of choice for the diagnosis of iron deficiency. Ferritin values occur on a continuum.
Take a nutrition history and provide dietary education to address dietary risk factors. Prescribe oral iron supplements as first line therapy for iron deficiency.
One preparation is not preferred over another; patient tolerance should be the guide. Anemia should correct in months. Continue oral iron for months after anemia corrects to replenish iron stores. Consider prescribing IV iron when there is inadequate response to oral iron, intolerance to oral iron therapy, or ongoing blood loss. Select Key Recommendations include see full recommendation list : CRP is the preferred first test to support a diagnosis of inflammatory or infectious conditions, rather than ESR.
Clinical features that together may prompt a requisition for CRP are: unexplained symptoms or a deterioration of health status; and an inflammatory or infectious disease is suspected; and a specific diagnosis is not made effectively by other means. Key recommendations include: Testing for testosterone deficiency is not recommended in asymptomatic men or women. The decision to test must be guided by medical history and clinical examination. Testosterone deficiency in men usually presents with a constellation of symptoms.
Erectile dysfunction in isolation is not an indication for testosterone testing. In men, serum total testosterone must be collected in the morning, preferably before 10AM, or within 3 hours of waking, and preferably in a fasting state. Men receiving stable androgen replacement can be tested annually. Testosterone testing is not useful for the investigation of low libido in women. Key changes to note include: The laboratory algorithm outlines changes to ordering. If central hypothyroidism is being investigated "suspicion of pituitary insufficiency" should be included as a clinical indication and a request for fT4 with or without TSH should be indicated in the space provided on the standard out-patient laboratory requisition.
Thyroid function test reports will include additional information. Laboratories in BC will be reporting trimester specific reference intervals as an appended comment on all women of child bearing age. Contact Us Questions, comments or suggestions?
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A large percentage of these people have diabetes, high blood pressure the major causes of kidney damage , or both. Unless primary care providers identify these people as being at risk and start active management, these patients may silently progress to having irreversible renal failure. Therefore, it is up to primary care providers to screen and intervene long before patients feel unwell. New BC guidelines will help family doctors identify high-risk patients earlier and delay progression of kidney disease. Additionally, it is clear that being older than 60 years combined with any of the above risk factors multiplies the risk of developing kidney disease.
Guidelines for the management of chronic kidney disease: Rationale, development, and implementation
BC Guidelines are clinical practice guidelines and protocols that provide recommendations to B. Management of these conditions is beyond the scope of this guideline. However, in some cases, notes and alternatives to imaging are provided for additional clinical context. Updates in the revised version include discussion on the optimal concentration of vitamin D levels, dietary and supplemental information on vitamin D and a brief discussion on the controversies of vitamin D and chronic illness. The guideline scope includes diagnosis, investigation and management of iron deficiency in patients of all ages. It features a new algorithm for investigation of non-anemic iron deficiency in adults, a new appendix on pediatric iron doses and liquid formulations, updated medication tables, enhanced information on nutrition including vegetarian and vegan diets, and enhanced information on pediatrics. Select Key Recommendations include see full recommendation list :.