eGFR <60 mL/min/1.73 m² ≥3 months or ACR ≥3 mg/mmol; staged 1–5.
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • eGFR, ACR, U&E, bicarbonate, Ca, PO4, PTH (G3b+), Hb, vitamin D
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • BP <130/80 (lower if proteinuric)
- • ACEi/ARB if ACR >30
- • SGLT2i (dapagliflozin 10 mg) reduces progression
- • Statin
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Avoid NSAIDs / nephrotoxins
- • Sick-day rules
- • Vaccinate (flu, pneumococcal, HBV)
Referral criteria
- • Nephrology if eGFR <30, ACR >70, rapid decline, refractory HTN
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
