Who to test for CKD (using GFR and ACR) | Who to refer for specialist assessment |
---|---|
Diabetes mellitus | GFR <30 mL/min/1.73 m2 with or without diabetes |
Hypertension | ACR ≥70 mg/mmol unless caused by diabetes and appropriately treated |
Acute kidney injury | ACR ≥30 mg/mmol together with haematuria |
Cardiovascular disease | Sustained decrease in GFR ≥25% and a change in GFR category or sustained decrease in GFR ≥15 mL/min/1.73 m2 or more within 12 months |
Structural renal tract disease | Poorly controlled hypertension despite at least four agents at therapeutic doses |
Multisystem diseases with potential kidney involvement eg SLE | Known or suspected rare or genetic cause of CKD |
Family history of end-stage kidney disease or hereditary kidney disease | Suspected renal artery stenosis |
Opportunistic detection of haematuria |
eGFR should also be monitored at least annually in people prescribed drugs known to be nephrotoxic, such as calcineurin inhibitors (for example, cyclosporin or tacrolimus), lithium and non-steroidal anti-inflammatory drugs. ACR = albumin to creatinine ratio; CKD = chronic kidney disease; GFR = glomerular filtration rate; SLE = systemic lupus erythematosus.