I have a new finding of eGFR 30 - 59 (Stage 3 CKD)

• Review patient soon looking for any obvious reason for low eGFR such as....
• acute illness
• bladder outflow obstruction
• medication review - any new drugs e.g. diuretics, NSAIDs, ACEIs / ARBs
• heart failure / sepsis

 

• Send urine sample for ACR and MSU and stick test for haematuria

 

• Repeat eGFR within 5 days to ensure no rapid deterioration

 

What to do next

 

 If the eGFR has fallen by > 25%:

If the eGFR has fallen by > 25% then consider urgent referral or contact on-call renal consultant if patient unwell and concerned about acute renal failure.

 

If the eGFR has fallen by 10% to 25%

Review patient soon looking for any obvious reason for low eGFR

•  acute illness
• bladder outflow obstruction
• medication review – any new drugs e.g. diuretic, NSAIDs, ACEIs / ARBs
• heart failure / sepsis

Next -

• Send urine for ACR and MSU
• Routine referral

 If patient unwell and concerned about acute renal failure – consider telephone referral to on call renal consultant.

 

If the eGFR is stable 30 - 59

If urine testing results are negative and eGFR known to be stable then follow

CKD stage 3 management guidelines

However, if the urine test results are abnormal then proceed as follows:

• If any visible haematuria refer to urology
• If any non visible haematuria (stick +ve) age > 40 years refer to urology
• If ACR between 30 and 70 then repeat ACR using early morning urine to confirm, then ...

If:

• ACR < 70 and no haematuria then CKD stage 3 management guidelines
• ACR > 30 and haematuria then refer to renal medicine
• ACR > 70 then refer to renal medicine
• ACR > 250 then urgent referral to renal medicine
• if unsure, consider e-Advice

 

Review any previous eGFR results – if eGFR fallen by >25%

If the eGFR has fallen by > 25% then consider urgent referral or contact on-call renal consultant if patient unwell and concerned about acute renal failure