Evaluation & definition of progression

GFR and albuminuria grid to reflect the risk of progression by intensity of coloring
Evaluation of CKD

GFR and albuminuria grid to reflect the risk of progression by intensity of coloring (green, yellow, orange, red, deep red).

The numbers in the boxes are a guide to the frequency of monitoring (number of times per year). Green reflects stable disease, with follow-up measurements annually if CKD is present; yellow requires caution and measurements at least once per year; orange requires measurements twice per year; red requires measurements at 3 times per year while deep red may require closest monitoring approximately 4 times or more per year (at least every 1–-3 months).

These are general parameters only based on expert opinion and must take into account underlying comorbid conditions and disease state, as well as the likelihood of impacting a change in management for any individual patient. CKD, chronic kidney disease; GFR, glomerular filtration rate. Modified with permission from Macmillan Publishers Ltd: Kidney International. Levey AS, de Jong PE, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 2011; 80: 17–28; accessed www.nature.com/ki/journal/v80/n1/full/ki2010483a.html

Evaluation of chronicity

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

Evaluation of cause

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

Evaluation of GFR

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

Evaluation of albuminuria

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

Definition of progression

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

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