Chronic Kidney Disease (CKD) Algorithm - NHS Cumbria

First steps & stagingIs there evidence of active renal diseaseor acute kidney injury? See Box 1NOStage the CKDYESConsider referral to nephrologist or urologist forinpatient / urgent outpatient assessmentBox 1 - Features of active renaldisease/acute kidney injury• In people aged > 70 years, an eGFR in the range 45–59 ml/min, if stable over time and withoutany other evidence of kidney damage, is unlikely to be associated with CKD-related complications• Test eGFR annually in at risk groups, during intercurrent illness and perioperatively in all patientswith CKD• Exact frequency depends on the clinical situationStageeGFR ml/in/1.73m 2Stages of CKD and frequency of eGFR testingTypical testingfrequency1 > 90 Normal or increased GFR, with other evidence of kidney disease 12 monthly2 60-89 Slight decrease in GFR, with other evidence of kidney disease 12 monthly3A 45-593B 30-444 15-29Moderate decrease in GFR, with or without other evidence ofkidney diseaseModerate decrease in GFR, with or without other evidence ofkidney diseaseSevere decrease in GFR, with or without other evidence ofkidney damage6 monthly6 monthly3 monthly5 < 15 Established renal failure 6 weeklyAre there features that cause particularconcern? e.g.:• Oliguria• Loin pain• Hyperkalaemia (K>7mmol/l)• Severe hypertension• Nephrotic syndrome• Haematoproteinuria (urinalysis in allcases) (NCG 73 page 8)• Lower urinary tract symptoms and signs(dysuria, obstructive symptoms)• Acute systemic symptoms (rash,arthritis, vomiting ,diarrhoea, rigors,confusion)Repeat eGFR within 3 days if any of theabove are present. Refer urgently if eGFRhas fallen by > 5 mL/min.Chronic Kidney Disease (CKD) Algorithm | Page 3