CKD - Definition, classification and staging

Question 1

CKD stage(s) that is(are) usually asymptomatic

Answer 1

Stages 1 and 2 CKD

Question 2

With progression to CKD stages 3 and 4, clinical and laboratory complications become more prominent; virtually all organ systems are affected, but the most evident complications include:

Answer 2

• Anemia and associated easy fatigability
• Decreased appetite with progressive malnutrition
• Abnormalities in calcium, phosphorus, and mineral-regulating hormones, such as 1,25(OH)₂D₃ (calcitriol), parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23)
• Abnormalities in sodium, potassium, water, and acid-base homeostasis

Question 3

T/F. All patients with decreased eGFR should be referred to a nephrologist

Answer 3

Primary care physician is advised to recheck kidney function, and if it is stable and not associated with proteinuria, the patient can usually be followed with interval repeat testing without referral to nephrologist

• Note:*
• If repeat testing shows declining GFR, albuminuria, or uncontrolled hypertension, referral to a nephrologist is appropriate

Question 4

GFR categories

Answer 4

• G1
  
  • Normal or high
    
    • ≥ 90
• G2
  
  • Mildly decreased
    
    • 60-89
• G3a
  
  • Mildly to moderately decreased
    
    • 45-69
• G3b
  
  • Moderately to severely decreased
    
    • 30-44
• G4
  
  • Severely decreased
    
    • 15-29
• G5
  
  • Kidney failure
    
    • < 15