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 a confirmed eGFR < 60 mL/min/1.73 m² and/or an ACR ≥ 3 mg/mmol (or another marker of kidney damage such as haematuria or structural disease) that persists beyond 3 months. 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) and to 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 AKI, structural renal-tract disease, stones or prostatic hypertrophy, gout, multisystem disease (e.g. SLE), a family history of kidney failure or hereditary kidney disease, or 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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