CKD1 – 5
Other evidence of chronic kidney damage
Renal USS if
Identifying progress
ACR
ACEi & ARB
Hypertension targets
Referral
CKD1 [>90 with other evidence of chronic kidney damage*]
- Monitor 12 monthly U&E
CKD2 [60-89 with other evidence of chronic kidney damage*]
- Monitor 12 monthly U&E
CKD3a [45-59] [> 70y old, if stable over time, unlikely of clinical significance]
- Monitor 6 monthly U&E
- Check ACR
CKD3b [30-44]
- Monitor 6 monthly U&E
- Check Hb, ACR
CKD4 [15-29]
- Monitory 3 monthly U&Es
- Check Hb, calcium, phosphate and PTH, ACR
CKD5 [<15 or on dialysis]
- Monitor 6 weekly U&E
- Check Hb, calcium, phosphate and PTH, ACR
*Other evidence of chronic kidney damage
- If CKD2 and none of below, do not subject to further investigations
- Persistent microalbuminuria
- Persistent proteinuria [morning ACR]
- Persistent haematuria (after exclusion of other causes, e.g. urological disease)
- Structural abnormalities on imaging (e.g. PCOS, reflux nephropathy)
Renal USS if
- Progressive CKD
- Macroscopic or persistent microscopic haematuria
- Suspected urinary tract obstruction
- Fhx of polycystic kidney disease and > 20
- CKD4 or 5
Identifying progress
- Newly identified – repeat eGFR within 2/52 [to exclude acute decline]
- Known cases – obtain minimum of 3 eGFR over 3/12
- Progression is eGFR decline [>5 in 1y] or [>10 within 5y]
ACR
- Clinically significant proteinuria when [ACR >= 30]
- Microalbuminuria
- Men – ACR > 2.5
- Women – ACR > 3.5
ACEi & ARB
- Offer if microalbuminuria or proteinuria
- Drug of choice in hypertension and CKD
- Starting and monitoring
- U&Es 1-2/52 after dose change
- Do not start if K significantly above normal range
- Stop ACE/ARB if [k>= 6]
- Stop or reduce to last dose if [eGFR drop >= 25% or creatine increase >= 30%]
- If [eGFR drop < 25% or creatine increase < 30%] then recheck U&Es after 1-2/52 to ensure no further decline.
Hypertension targets
- Target < 130/80 if [CKD and diabetes] or [ACR > 70]
- Target < 140/90 in others
Referral
- CKD4 and 5
- ACR >= 70
- ACR >= 30 and haematuria
- eGFR decline [>5 in 1y] or [>10 within 5y]
- HTN despite 4 anti-hypertensives
- Suspected renal artery stenosis or rare/genetic cause for CKD