Chronic Kidney Disease (CKD)

🔍 When to Suspect

Often asymptomatic; consider in patients with diabetes, hypertension, CVD, or family history of kidney disease; late symptoms include uraemia or urinary obstruction

From the full topic in The Ocean Library: Chronic Kidney Disease (CKD)

🧭 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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