Evaluation & definition of progression

In people with GFR <60 ml/min/1.73 m² (GFR categories G3a-G5) or markers of kidney damage, review past history and previous measurements to determine duration of kidney disease.¹

• If duration is >3 months, CKD is confirmed. Follow recommendations for CKD.¹
• If duration is not >3 months or unclear, CKD is not confirmed. Patients may have CKD or acute kidney diseases (including acute kidney injury (AKI)) or both and tests should be repeated accordingly.¹

Evaluate the clinical context, including personal and family history, social and environmental factors, medications, physical examination, laboratory measures, imaging, and pathologic diagnosis to determine the causes of kidney disease.¹

The nephrological community recommends using serum creatinine and a GFR estimating equation for initial assessment.¹

It is also suggested to use additional tests (such as cystatin C or a clearance measurement) for confirmatory testing in specific circumstances when eGFR based on serum creatinine is less accurate.¹

For initial testing of proteinuria the nephrological community suggests, if possible, early morning urine sample, and the following measurements: Urine albumin to creatinine ratio (ACR); Urine protein-to-creatinine ratio; Reagent strip urinalysis for total protein with automated reading; Reagent strip urinalysis for total protein with manual reading.¹

It is recommended that clinical laboratories report ACR and protein-to-creatinine ratio in untimed urine samples in addition to albumin concentration or proteinuria concentrations rather than the concentrations alone.¹

The term microalbuminuria should no longer be used by laboratories.¹

Assess GFR and albuminuria at least annually in people with CKD. Assess GFR and albuminuria more often for individuals at higher risk of progression, and/or where measurement will impact therapeutic decisions. The grid below shows the recommended minimum number of visits.¹