Case Studies

The grid below is a “Risk Map” for chronic kidney disease (CKD) that reflects prognosis, recommended frequency of monitoring, and indications for nephrology referral. To see case studies, click on a colored box in the grid below. 

 

CKD is classified based on:

Albuminuria categories
Description and range
A1 A2 A3
Normal to mildly increased Moderately increased Severely increased
< 30 mg/g
< 3 mg/mmol
30 – 299 mg/g
3 – 29 mg/mmol
≥ 300 mg/g
≥ 30 mg/mmol

GFR categories (ml/min/1.73 m 2) Description and range

G1 Normal or high ≥ 90 Monitor
1
Monitor
1
Refer*
2
G2 Mildly decreased 60 – 89 Monitor
1
Monitor
1
Refer*
2
G3a Mildly to moderately decreased 45 – 59 Monitor
1
Monitor
2
Refer
3
G3b Moderately to severely decreased 30 – 44 Monitor
2
Monitor
3
Refer
3
G4 Severely decreased 15 – 29 Refer*
3
Refer*
3
Refer
4+
G5 Kidney Failure < 15 Refer
4+
Refer
4+
Refer
4+

Adapted with permission from KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013;Suppl.3:1-150.

Key to Figure:

Colors: Represents the risk for progression, morbidity and mortality by color from best to worst. Green: low risk (if no other markers of kidney disease, no CKD); Yellow: moderately increased risk; Orange: high risk; Red, very high risk; Deep red, highest risk.

Numbers: Represent a recommendation for the number of times per year the patient should be monitored.

Refer: Indicates that nephrology referral and services are recommended.
*Referring clinicians may wish to discuss with their nephrology service depending on local arrangements regarding monitoring or referral.