4 Chronic Kidney Disease Practice Questions

Identify and assess CKD

Chronic kidney disease (CKD) is established by kidney abnormalities that persist for at least $3$ months. These may include reduced eGFR or another marker of kidney damage. A single abnormal result may be temporary and usually needs confirmation in clinical context; for example, one raised urine albumin result during a urinary infection or a creatinine increase after dehydration is not enough by itself to establish chronic disease.

Assessment and monitoring routinely use both eGFR and UACR. eGFR estimates filtering function, while UACR measures albumin in urine and provides a marker of kidney damage and risk.

Interpret kidney test results

CKD risk and follow-up are assessed using both eGFR and albuminuria, alongside the cause of disease and the person’s overall health. For example, an eGFR of $42\ \text{mL/min/1.73 m}^2$ together with a UACR of $420\ \text{mg/g}$ indicates that both reduced eGFR and severely increased albuminuria are important risk markers. A UACR above $300\ \text{mg/g}$ is considered severely increased. These results do not prove that kidney failure will occur soon or predict an individual’s exact course.

Use trends to monitor progression

A sustained decline in eGFR and a persistent rise in UACR may suggest that CKD is progressing. Repeated results and trends are more informative than a single measurement because temporary illness, hydration, medicines, and normal test variability can affect results. Monitoring frequency is individualized according to risk and the person’s clinical situation.

Monitor kidney-protective medicines

ACE inhibitors and ARBs can benefit many people with albuminuric CKD. After starting one or increasing its dose, check blood pressure, serum creatinine, and potassium within about $2$–$4$ weeks, as clinically appropriate. A modest early change in eGFR may be expected; a larger decline or another concerning change calls for evaluation rather than automatic discontinuation.

When eGFR falls after a kidney-protective medicine is started, consider which medicine was used, when it was started, blood pressure, symptoms, potassium, hydration or recent illness, other medicines, and the size and persistence of the change. Some treatments cause an expected early dip, so a decline does not automatically mean permanent progression or drug injury. A decline greater than $30\%$ after starting a hemodynamically active treatment warrants evaluation.

Understand SGLT2 inhibitor treatment

SGLT2 inhibitors may protect kidney and cardiovascular health in eligible people with CKD, including some people without diabetes. The described eligible groups include adults with eGFR at least $20\ \text{mL/min/1.73 m}^2$ and UACR at least $200\ \text{mg/g}$, or people with heart failure regardless of albuminuria; other groups may also be considered. A small, early, reversible eGFR dip can occur. Eligibility and treatment decisions should be individualized, and starting an SGLT2 inhibitor does not remove the need for routine CKD monitoring.

Reduce further kidney damage

Ways to help reduce the risk of further kidney damage include following the treatment plan for high blood pressure or diabetes, taking prescribed medicines as directed, reviewing all medicines and supplements with a clinician, avoiding unnecessary NSAID use, not smoking, and keeping recommended follow-up appointments.

Food and fluid needs are not the same for everyone with CKD. Recommendations depend on kidney function, medicines, blood test results, symptoms, and other health conditions. Nutrition, activity, and weight-management advice should be individualized with the care team or a kidney dietitian; everyone with CKD should not automatically be told to severely restrict fluids or avoid all foods containing potassium. Keeping a record of kidney test results and medicines can support follow-up.

Plan ahead for advanced CKD

People with advanced CKD should discuss future treatment choices with the kidney-care team before an urgent need arises. Early, shared planning allows time to learn about dialysis options, transplant evaluation, and conservative supportive care, and to consider personal preferences and prepare. The appropriate timing depends on symptoms, test results, and individual goals; eGFR alone does not set a universal start date.

• ACE inhibitor

• NSAIDs