Chronic kidney disease

Panel 2: Five-step guide for the detection and assessment 
of chronic kidney disease
1 Recognition of increased risk of CKD
• Increased susceptibility to CKD (ie, old age, family history, 
history of acute kidney injury, member of ethnic or racial 
minority in the USA, reduced nephron mass [history of 
nephrectomy, low birthweight], genetic traits)
• Exposure to diseases or conditions that cause CKD—ie, risk 
factors for CVD (hypertension, diabetes, obesity), CVD, 
autoimmune disease (systemic lupus erythematosus, 
vasculitis), infections (bacteria, HBV, HCV, HIV, 
schistosomiasis, malaria), drugs or toxins (NSAID, 
iodinated radiographic contrast, aristolochic acid)
2 Testing 
for 
CKD
• Measure serum creatinine to estimate GFR
• Measure 
urinary 
albumin
• Search for other markers of kidney damage that are 
specifi c to the risk (urine sediment, imaging 
abnormalities, or renal tubular syndromes)
• Confi rmatory tests (if indicated)
3 Detection 
of 
CKD
• GFR <60 mL/min per 1·73 m² (measured or estimated)
• Kidney damage (pathological abnormalities, markers, or 
history of kidney transplantation)
• Duration >3 months (documented or inferred)
4 Evaluation of clinical diagnosis for implementation 
of specifi c therapy
• Diabetic kidney disease (type 1 or type 2)
• Non-diabetic kidney disease (glomerular diseases other 
than diabetic kidney disease, vascular diseases, 
tubulointerstitial diseases, or cystic diseases)
• Kidney disease in recipients of kidney transplants
5 Assessment of stage for implementation 
of stage-based non-specifi c therapy
• GFR 
stages
• Albuminuria 
stages
CKD=chronic kidney disease. CVD=cardiovascular disease. HBV=hepatitis B virus. 
HCV=hepatitis C virus. NSAID=non-steroidal anti-infl ammatory drug. GFR=glomerular 
fi ltration rate.

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