Abnormalities of kidney structure or function present for >3 months — eGFR <60 or markers of damage (e.g., albuminuria).
History taking
- • Diabetes, hypertension, recurrent UTIs, NSAID use, family history of kidney disease
- • Fatigue, oedema, frothy urine, nocturia, pruritus, anorexia, hiccups
Examination
- • BP, volume status (JVP, oedema, lung crackles), pallor
- • Bladder, ballotable kidneys (polycystic), AV fistula if any
Red flags
- • Hyperkalaemia (K >6 with ECG changes), acidosis, fluid overload
- • Uraemic encephalopathy, pericarditis, bleeding
- • Rapidly progressive renal failure
Differential diagnosis
- • AKI on CKD, diabetic nephropathy, hypertensive nephrosclerosis
- • Glomerulonephritis, obstructive uropathy, ADPKD
Recommended investigations
- • Serum creatinine, eGFR (CKD-EPI), urea, electrolytes (K, Na, Ca, P, HCO₃)
- • Urinalysis, urine ACR (preferred), urine PCR
- • USG KUB; Hb (anaemia), iPTH, vitamin D, lipid profile
Diagnosis
- • Stage by eGFR (G1–G5) and albuminuria (A1–A3)
Initial treatment / management
- • BP target <130/80; ACEI/ARB preferred (esp. proteinuria)
- • Glycaemic control; SGLT2i for diabetic & non-diabetic CKD
- • Treat anaemia (iron, ESA), bone-mineral disorder, acidosis
- • Avoid nephrotoxins (NSAIDs, contrast, aminoglycosides)
Prescription examples
- • Tab Telmisartan 40 mg PO OD
- • Tab Dapagliflozin 10 mg PO OD (if eGFR ≥20)
- • Tab Sodium bicarbonate 500 mg PO TDS (if HCO₃ <22)
- • Tab Calcium carbonate 500 mg PO TDS with meals if hyperphosphataemia
Follow-up advice
- • Stage-based: G3a 6-monthly, G3b–4 quarterly, G5 monthly
- • Vaccinations: hepatitis B (pre-dialysis), influenza, pneumococcal
Patient counselling
- • Low-salt, moderate-protein diet; potassium/phosphate as advised
- • Avoid OTC NSAIDs and herbal nephrotoxins
- • Prepare for renal replacement therapy at G4
Referral criteria
- • eGFR <30, rapid decline, refractory complications
- • Suspected glomerulonephritis or autoimmune cause
- • Plan vascular access and transplant work-up early
Clinical pearls
- • Always check ACR, not just creatinine, in diabetes
- • SGLT2i slow CKD progression even without diabetes
- • AKI on CKD requires hospital evaluation
References
- • KDIGO CKD Guideline 2024
- • KDIGO Diabetes in CKD 2022
Educational outpatient guide — verify against local guidelines before clinical use.
