What management is recommended for an eGFR (estimated Glomerular Filtration Rate) of 90?

Management of eGFR 90 mL/min/1.73 m²

An eGFR of 90 mL/min/1.73 m² represents normal or near-normal kidney function (CKD Stage 1 if kidney damage is present, or no CKD if no damage markers exist), and requires annual monitoring with assessment for albuminuria to determine if chronic kidney disease is actually present. 1

Determining if CKD is Present

• eGFR ≥90 mL/min/1.73 m² alone does NOT diagnose CKD – you must document persistent kidney damage through albuminuria (urine albumin-to-creatinine ratio [UACR] ≥30 mg/g), hematuria, or structural abnormalities lasting >3 months 1, 2
• Obtain a spot urine UACR to screen for albuminuria 1
• If UACR is <30 mg/g and no other kidney damage markers exist, this patient does NOT have CKD and requires only standard preventive care 2
• If UACR ≥30 mg/g on two occasions separated by at least 3 months, diagnose CKD Stage 1 (normal eGFR with kidney damage) 1

Monitoring Recommendations

If No CKD (eGFR 90 + UACR <30 mg/g):

• Annual screening with serum creatinine, eGFR calculation, and UACR if diabetes or hypertension is present 1
• For patients with diabetes, screening should occur annually starting at diagnosis for type 2 diabetes or 5 years after diagnosis for type 1 diabetes 1

If CKD Stage 1 (eGFR 90 + UACR ≥30 mg/g):

• Annual assessment of serum creatinine and eGFR 3
• Annual UACR measurement 3
• Blood pressure monitoring at each visit with target <130/80 mmHg if albuminuria is present 1, 3

Medication Management

At eGFR 90 mL/min/1.73 m², no medication dose adjustments are required – this level of kidney function allows standard dosing of essentially all medications 3

If Albuminuria is Present (UACR ≥30 mg/g):

• Initiate ACE inhibitor or ARB therapy regardless of blood pressure if UACR >300 mg/g (macroalbuminuria), titrated to maximum tolerated dose 1
• Consider ACE inhibitor or ARB if UACR 30-300 mg/g (microalbuminuria), particularly in diabetic patients 1
• If diabetes is present, initiate SGLT2 inhibitor with proven kidney benefit (empagliflozin, canagliflozin, or dapagliflozin) 1
• Statin therapy: moderate-intensity for primary prevention or high-intensity if established atherosclerotic cardiovascular disease is present 1

Cardiovascular Risk Management

Patients with even early-stage CKD face elevated cardiovascular risk that requires aggressive risk factor modification 1

• Target blood pressure <130/80 mmHg if albuminuria is present 1
• Target blood pressure ≤140/90 mmHg if no albuminuria 1
• Optimize glycemic control if diabetic (hemoglobin A1C individualized but generally <7%) 1
• Initiate statin therapy for lipid management 1
• Smoking cessation is mandatory 1, 3

Lifestyle Modifications

• Dietary sodium restriction to <2 g/day (5 g sodium chloride) 1
• Higher diet quality is associated with decreased risk of eGFR decline and should be emphasized 4
• Regular physical activity reduces mortality risk in CKD patients 5
• Avoid high protein intake (>1.3 g/kg/day) if progressive kidney disease develops, though at eGFR 90 this is not yet a concern 1
• Avoid nephrotoxic medications, particularly NSAIDs for prolonged periods 3

When to Increase Monitoring Frequency

• If eGFR declines to <60 mL/min/1.73 m² on repeat testing, increase monitoring to every 6 months 3
• If rapid eGFR decline occurs (>5 mL/min/1.73 m² per year), increase monitoring frequency and consider nephrology referral 3
• If UACR increases to >300 mg/g, intensify treatment and consider nephrology consultation 3

Nephrology Referral Indications

Consider nephrology referral if any of the following develop 3:

• Rapid decline in eGFR (>5 mL/min/1.73 m² per year)
• Significant proteinuria (UACR >300 mg/g)
• Difficult-to-control hypertension despite multiple agents
• Suspected non-diabetic kidney disease (hematuria, rapid progression without albuminuria, absence of diabetic retinopathy in diabetic patients)

Key Clinical Pitfall

The most common error is diagnosing CKD based solely on eGFR ≥60 mL/min/1.73 m² without documenting persistent kidney damage – this misclassification can lead to unnecessary patient anxiety, insurance complications, and inappropriate treatment 2. Always confirm the presence of albuminuria or other damage markers before labeling a patient with normal eGFR as having CKD.