The Assessment of Care Quiz

Take the following test to assess the quality of care that you are receiving from your doctor to treat your kidney failure. You will need access to your latest lab values from a recent exam. If you do not have a copy of this report, call your doctor's office to ask for a copy.

The first two questions are intended to ascertain if you have kidney failure and are not scored. Questions 3 through 14 are scored as 0 to 10 points each and are intended to assess the quality of care you are receiving.

1. Do you have kidney disease? As noted in Chapter 4, the quickest way to find out (although it is not infallible) is to check your urine for protein. Buy paper test strips from the pharmacy and hold a strip in your urinary stream. If you have protein or glucose in your urine, the color will change (see package insert). If the color doesn't change, you probably do not have kidney disease (or diabetes) and do not need to take this quiz. If you do have protein or glucose in your urine that was not previously recognized, you may need to consult your doctor. But note that the transient appearance of protein in the urine can also be caused by vigorous exercise, infection, fever, or very high blood sugar. You may want to check it again before you consult your doctor.

2. Do you have kidney failure? Look up your blood serum (or blood plasma) creatinine concentration on your lab report. If several lab results show that it is repeatedly 2 mg per dl or higher, you probably have chronic kidney failure and require medical care. Take the rest of this quiz to see if you are getting adequate care. If your creatinine concentration is lower than 2 mg per dl, you may not have kidney failure and do not need to take this quiz. If your creatinine concentration is higher than the upper level of normal (which varies somewhat in different laboratories, but is always printed on the lab report) but is less than 2 mg per dl, get it checked again after a month or so. If it remains in this range, consult your physician. Note that some people show elevated creatinine levels long before they show protein in their urine.

3. Is your blood pressure well regulated? It should be less than 130/80. If it is, give yourself 10 points. If only the first value (the systolic pressure) meets this target, score 5 points. If only the second value (the diastolic pressure) meets this target, score 5 points. (See Chapter 9.)

4. Do you have any symptoms of kidney failure (such as fatigue, muscle cramps, itching, nausea, or vomiting)? If so, you already may have been advised by a dietitian to eat a low-protein diet or a very-low-protein diet with a supplement of essential amino acids. If so (whether you have symptoms or not), give yourself 10 points. (See Chapter 7.)

5. Do you have severe anemia? This can be measured by several tests; the most widely used is the hematocrit (the percentage of your blood that red cells occupy). If your hematocrit is less than 30 percent and you have symptoms such as fatigue or shortness of breath on exertion, you have severe anemia and you should be getting injections of a hormone that stimulates your bone marrow to produce more red cells. Injections of Epogen or Procrit will bring your hematocrit above 30 percent. If your hematocrit is less than 30 percent and you are getting injections of this hormone, award yourself 5 points. If your hemat-ocrit is over 30 percent, give yourself 10 points. (See Chapter 11.)

6. Are you receiving one of the many drugs that inhibit the formation or action of a hormone called angiotensin? These are collectively called either angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs). Many drugs are available in each of these classes. You may need to ask your doctor about this. If you are receiving one of these drugs, award yourself 10 points. If you were receiving one of them, but it was discontinued for some reason, or if your kidney disease is so severe (creatinine level over 4 mg per dl) that the use of these drugs would be dangerous, award yourself 10 points.

7. Is your serum potassium being checked, and is it less than 5.5 millequiva-lentsper liter? If so, add 10 points to your score. (See Chapter 12.)

8. Is your serum carbon dioxide (bicarbonate) concentration being checked, and is it over 20 millimolar? If so, add 10 points to your score. (See Chapter 10.)

9. Is your serum calcium concentration between 8.6 and 10.6 mg per dl? If so, add 10 points to your score. (See Chapter 13.)

10. Is your serum phosphorus concentration less than 5 mg per dl? If so, add 10 points to your score. (See Chapter 13.)

11. Is your serum cholesterol concentration less than 200 mg per dl? If so, add 10 points to your score. (See Chapter 15.)

12. Are your ankles swollen? If so, you should be taking a diuretic drug. If you are, or if your ankles are not swollen, add 10 points to your score. (See Chapter 8.)

13. If you are diabetic, is your hemoglobin A1C concentration less than 7 percent? (Hemoglobin A1C is a form of hemoglobin that has combined with glucose; a prolonged elevation of blood glucose level causes this combination to occur.) If so, add 10 points. If you have IgA nephropathy and are receiving fish oil, add another 10 points. (This form of kidney disease represents an immune response to a protein, IgA, which is a specific immunoglobulin. It has been well established that this disease responds to fish oil treatment.) If you have neither of these disorders, you still get 10 points.

14. Is your serum albumin concentration greater than 3.5 g per dl? If so, award yourself another 10 points.

Quiz Scoring

Now add up your total score.

If you scored less than 15points: You care is being neglected. You may rapidly progress to dialysis. You may also sustain a serious or fatal complication even before your kidneys fail. You may need to change doctors, or at least discuss the situation with your doctor.

If you scored between 15 and 45 points: Your care could be a lot better. You will probably not do well and may go on dialysis before long unless your care improves.

If you scored between 45 and 70 points: Clearly you are receiving some attention, but some things could be improved that may affect your outcome.

If you scored greater than 70 points: Your physician is trying hard. Perhaps he or she could do even better. Care like this may stop progression of your kidney disease for years or even for the indefinite future. If you scored 120points: A perfect score. Congratulations to you and to your physician!

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