Chronic Kidney Disease Management

Diagnosis and Evaluation

The KDIGO guidelines define CKD stage 3b as an eGFR of 30-44 mL/min/1.73m², which requires evaluation of underlying causes and implementation of kidney-protective strategies 1
To confirm chronicity, determine if the kidney disease is acute, chronic, or acute-on-chronic, and review previous laboratory values to establish duration ≥3 months 2
If no previous values are available, do not assume chronicity based on a single measurement 1

Assess for diabetes, hypertension, cardiovascular disease, and review medication history for nephrotoxic agents (NSAIDs, certain antibiotics) 1
Urinalysis with microscopy and urine albumin-to-creatinine ratio (UACR) can help quantify albuminuria and assess for proteinuria, hematuria, and casts 1
Consider cystatin C measurement for more accurate GFR assessment, especially if creatinine may be affected by non-renal factors 1, 3

The American College of Cardiology recommends blood pressure control (target <130/80 mmHg for most CKD patients) and glycemic control if diabetic (HbA1c target individualized based on comorbidities) 4
RAAS blockade (ACEi or ARB) is recommended if proteinuric, and consider SGLT2 inhibitors if diabetic or heart failure is present 4
Lipid management, lifestyle modifications (smoking cessation, weight management, physical activity), and antiplatelet therapy if indicated can help reduce cardiovascular risk 4

Repeat BUN, creatinine, and eGFR in 2-4 weeks to assess stability or progression, and monitor electrolytes, especially if initiating RAAS blockers 5
Regular assessment of kidney function every 3-6 months based on stability, and monitor for rapid progression (decline in eGFR >5 mL/min/1.73m² per year) 5
The KDIGO guidelines recommend checking for albuminuria every 6-12 months 1

Consider nephrology referral if rapid progression, heavy proteinuria, difficult-to-control hypertension, recurrent AKI episodes, suspected glomerular disease, or eGFR <30 mL/min/1.73m² for transplant planning 1
Avoid nephrotoxic medications (NSAIDs, aminoglycosides, contrast agents) when possible, and do not discontinue RAAS inhibitors for mild, stable elevations in creatinine (<30% from baseline) 3, 4