What is the management plan for impaired renal function with an eGFR of 62 and creatinine level of 1.13?

Management of eGFR 62 and Creatinine 1.13 at Age 42

This represents Stage 2 CKD (eGFR 60-89 mL/min/1.73 m²) with mildly reduced kidney function that requires confirmation, investigation of underlying cause, and annual monitoring—but does not yet necessitate medication dose adjustments or nephrology referral unless albuminuria or rapid progression is present. 1

Confirm the Diagnosis

• Repeat eGFR and creatinine within 3 months to confirm persistence, as a single measurement is insufficient for CKD diagnosis 2
• Obtain a spot urine albumin-to-creatinine ratio (UACR) immediately, as albuminuria >30 mg/g confirms kidney damage even at this eGFR level and fundamentally changes management 1, 2
• Consider measuring cystatin C if the repeat eGFR remains 45-59 mL/min/1.73 m² without albuminuria, as this confirms true CKD in approximately two-thirds of cases and identifies those at markedly elevated cardiovascular risk 2
• Rule out exogenous factors that falsely elevate creatinine: ask specifically about creatine supplements, high protein intake, and recent strenuous exercise, as these can artificially lower calculated eGFR 3

Investigate the Underlying Cause

• Screen for diabetes if not already diagnosed, as hyperglycemia accelerates kidney disease progression and is the leading cause of CKD in the U.S. 1, 2
• Assess for hypertension at every visit, as uncontrolled blood pressure drives CKD progression 1, 2
• Consider non-diabetic kidney disease if any of the following are present: active urine sediment (red blood cells or cellular casts), rapidly declining eGFR, rapidly increasing or very high UACR, or absence of diabetic retinopathy in type 1 diabetes 1

Medication Review and Nephrotoxin Avoidance

• Discontinue or avoid NSAIDs (including over-the-counter ibuprofen and naproxen), as these are nephrotoxic and accelerate CKD progression 2
• Minimize contrast dye exposure—use only when absolutely necessary and ensure adequate hydration beforehand 2
• Review all current medications for appropriate renal dosing, though at eGFR 62 mL/min/1.73 m², most medications do not yet require adjustment 1, 4
• If metformin is being considered for diabetes, it can be safely initiated at this eGFR level, as FDA guidance only contraindicates initiation when eGFR <45 mL/min/1.73 m² 1

Cardiovascular Risk Reduction

• Target blood pressure <130/80 mmHg (or <125/75 mmHg if proteinuria is present), as lower systolic blood pressure correlates with slower renal disease progression 1, 2
• Initiate ACE inhibitor or ARB if albuminuria is present (UACR >30 mg/g), as these agents slow CKD progression in patients with proteinuria 1, 2
• Assess lipid profile and manage dyslipidemia aggressively, as CKD itself is an independent cardiovascular disease risk factor conferring approximately 16% increased cardiovascular mortality 2
• Counsel on smoking cessation if applicable, as smoking accelerates kidney disease 2

Establish Monitoring Schedule

• Assess eGFR and UACR at least annually going forward, as both parameters are required to guide treatment decisions and detect progression 1
• Monitor more frequently (every 3-6 months) if albuminuria is present, blood pressure is uncontrolled, or other high-risk features exist 2
• Define progression as sustained decline in eGFR >5 mL/min/1.73 m² per year or >25% reduction from baseline, though even smaller declines are associated with increased mortality risk 2

Lifestyle Modifications

• Sodium restriction to <2 grams daily to optimize blood pressure control 2
• Weight reduction if BMI >30 kg/m², as obesity accelerates kidney disease 2
• Moderate protein intake may be considered, though specific recommendations vary and should be individualized based on nutritional status 2

When to Refer to Nephrology

At this stage (eGFR 62), nephrology referral is not yet indicated unless: 2

• Rapidly progressive decline in eGFR (>5 mL/min/1.73 m² per year)
• Significant albuminuria (UACR >300 mg/g) or nephrotic-range proteinuria
• Active urinary sediment suggesting glomerulonephritis
• Uncertain etiology of kidney disease
• Difficult management issues including refractory hypertension

Critical Pitfalls to Avoid

• Do not ignore this finding simply because creatinine is "only" 1.13 mg/dL—at age 42, this represents reduced kidney function that requires investigation 1, 5
• Do not assume normal kidney function without checking UACR, as albuminuria may be present even at this eGFR level and dramatically increases cardiovascular risk 1, 2
• Do not delay repeat testing—confirm persistence within 3 months to avoid misclassifying acute kidney injury as CKD 2
• Do not prescribe NSAIDs for pain management, as these are particularly harmful in CKD 2