GPAtlas🧭 When to suspect
Chronic kidney disease (CKD) is abnormality of kidney function or structure present for more than 3 months.
In practice this means any of the following that persists beyond 3 months:
• A confirmed eGFR < 60 mL/min/1.73 m².
• An albumin:creatinine ratio (ACR) ≥ 3 mg/mmol.
• Another marker of kidney damage, such as haematuria or structural disease.
Most early CKD is entirely asymptomatic and is picked up on bloods or urine testing requested for another reason – symptoms of uraemia (nausea, anorexia, fatigue, pruritus) or of outflow obstruction tend to appear only in the later stages.
A single low eGFR is not CKD. A newly found eGFR < 60 must be repeated within 2 weeks to exclude acute kidney injury, and chronicity confirmed over ≥ 3 months before the label is applied.
The two core clinical skills in primary care are to:
• stage accurately by eGFR and ACR (the two axes that drive every decision)
• slow progression with renoprotective therapy and risk-factor control.
Offer eGFR and ACR testing to anyone with a risk factor:
• diabetes
• hypertension
• cardiovascular disease
• previous acute kidney injury (AKI)
• structural renal-tract disease, stones or prostatic hypertrophy
• gout
• multisystem disease (e.g. systemic lupus erythematosus [SLE])
• a family history of kidney failure or hereditary kidney disease
• nephrotoxic medication (long-term NSAIDs, lithium, calcineurin inhibitors)
Age, sex and ethnicity alone are not indications to test.
| GFR stage | eGFR (mL/min/1.73 m²) | Kidney function |
|---|---|---|
| G1 | ≥ 90 | Normal or high – CKD only if other markers of damage |
| G2 | 60–89 | Mild reduction – CKD only if other markers of damage |
| G3a | 45–59 | Mild to moderate reduction |
| G3b | 30–44 | Moderate to severe reduction |
| G4 | 15–29 | Severe reduction |
| G5 | < 15 | Kidney failure (end-stage) |
| ACR category | ACR (mg/mmol) | Albuminuria |
|---|---|---|
| A1 | < 3 | Normal to mildly increased |
| A2 | 3–30 | Moderately increased |
| A3 | > 30 | Severely increased |
Higher ACR and lower eGFR each independently raise the risk of progression, cardiovascular events and death, and multiply that risk in combination – which is why both numbers are needed to stage and to set management.
Source: NICE NG203 · UK Kidney Association
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