GFR categories (ml/min/1.73m2)
|
GFR Description
|
GFR Range
|
A1
Normal to mildly increased <3 |
A2
Moderately increased 3-30 |
A3 Severly increased >30
*nephrotic syndrome>220mg/mmol |
G1
|
Normal and high | >90 | No CKD in the absence of markers of kidney damage No CKD in the absence of markers of kidney damage |
Manage in primary care according to recommendations Refer to renal unit if the person has:
|
Manage in primary care according to recommendations Refer to renal unit if the person has any of the criteria in A2, or:
|
G2
|
Mild reduction related to normal range for a young adult | 60-89 | |||
G3a
|
Mild- moderate reduction | 45-59 | |||
G3b
|
Moderate-severe reduction | 30-44 | |||
G4
|
Severe reduction | 15-29 |
Refer for specialist assessment
|
||
G5
|
Kidney failure | <15 |
Management of Chronic Kidney Disease (CKD)
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Screening and Diagnosis of Chronic Kidney Disease
Renal complications
- Measure serum calcium, phosphate and PTH in people with GFR < 30 ml/min
- Check haemoglobin in people with GFR < 45ml/min
- Consider oral bicarbonate supplementation in patients with GFR < 30 and bicarbonate < 20 mmol/L
Frequency for monitoring of GFR (number of times per year, by GFR and ACR category) for people with or at risk of CKD
GFR Category
|
ACR Categories (mg/mmol) A1 <3 Normal to mildly increased |
ACR Categories (mg/mmol) A2 3-30 Moderately increased |
ACR Categories (mg/mmol) A3 >30 Severely increased |
G1 > 90 Normal and High |
≤ 1 | 1 | ≥ 1 |
G2 60-89 mild reduction related to normal range for young adult | ≤ 1 | 1 | ≥ 1 |
G3a 45-59 Mild- moderate reduction |
1 | 1 | 2 |
G3b 30-44 Moderate-severe reduction |
≤ 2 | 2 | ≥ 2 |
G4 15-29 Severe reduction |
2 | 2 | 3 |
G5 <15 Kidney failure |
4 | ≥ 4 | ≥ 4 |
This should be tailored according to:
- The underlying cause of CKD
- Past patterns of eGFR and ACR (but be aware CKD progression is often non linear)
- Co-morbidites especially heart failure
- Changes to treatment (such as ACEI/ARBs, NSAIDs, diuretics)
Abbreviation | Meaning |
DBP | Diastolic blood pressure |
SBP | Systolic blood pressure |
ACEI | Angiotensin-converting-enzyme inhibitors |
ARB | Angiotensin II receptor blockers |
ACR | Albumin-to-creatinine ratio |
U&Es | Urea and electrolytes |
GFR | Glomerular filtration rate |
MI | Myocardial infarction |
PTH | Parathyroid hormone |