Hello Dr. Spry, My CKD has progressed to ACR = 23,42 mg/mmol, eGFR-EPI = 40 (mL/p/1.73m2), p-urate = 559 umol/L (230 – 480), p-standard bicarbonate 21 mmol/L (22-27). Should I be concerned about a high risk of further progression and therefore 1) Should I ask for referral to a nephrologist? 2) Should I ask for the high urate to be treated? 3) Should I ask for bicarbonate therapy to be started?

I am not able to recommend medical therapy unless I am able to perform a complete history and physical examination.  I generally recommend referral to a nephrologist when the estimated glomerular filtration rate (eGFR) is less than 30 milliliters per minute per 1.73 meters squared.  However, if your primary care physician (PCP) is concerned or has questions, then referral may be appropriate.  Most PCP’s are very capable of caring for patients with Stage 3 chronic kidney disease (CKD) who have an eGFR between 30 and 60.

The decision about treatment of urate and sodium bicarbonate will need to take into consideration other aspects of your overall health and should be addressed by your physician.  Treatment of asymptomatic hyperuricemia is a complex area in medicine.


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