What is the management plan for an adult patient with a creatinine level of 0.9 mg/dL and an eGFR of 82 mL/min/1.73m², potentially indicating Chronic Kidney Disease (CKD)?

Normal Kidney Function - No Intervention Required

A creatinine of 0.9 mg/dL with an eGFR of 82 mL/min/1.73m² represents normal kidney function and does not indicate Chronic Kidney Disease (CKD). 1

Why This Does Not Meet CKD Criteria

• CKD requires BOTH an eGFR <60 mL/min/1.73m² OR albuminuria ≥30 mg/g persisting for at least 3 months - this patient has neither criterion met based on the eGFR alone 1, 2
• An eGFR ≥60 mL/min/1.73m² explicitly does not meet criteria for CKD diagnosis unless other markers of kidney damage are present 1
• Normal GFR for adults is approximately 130 mL/min/1.73m² for men, with a physiologic decline of 0.75 mL/min/year starting in the third or fourth decade, making an eGFR of 82 mL/min/1.73m² age-appropriate for most adults 1

Essential Next Step: Confirm Absence of Kidney Damage

Measure urinary albumin-to-creatinine ratio (UACR) on a random spot urine sample immediately to definitively rule out CKD, as kidney damage can exist with preserved eGFR 3, 2

• CKD Stage 1 (eGFR ≥90 mL/min/1.73m²) and Stage 2 (eGFR 60-89 mL/min/1.73m²) require evidence of kidney damage such as albuminuria, hematuria, or structural abnormalities to be diagnosed 2
• If UACR <30 mg/g (normal), this patient definitively does not have CKD 1, 2
• If UACR ≥30 mg/g, CKD Stage 2 would be diagnosed and require further evaluation 2

Management Based on UACR Results

If UACR <30 mg/g (Normal - Most Likely Scenario):

• No CKD-specific interventions are needed 1
• Screen for CKD risk factors: diabetes, hypertension, age >60 years, family history of kidney disease, cardiovascular disease 2
• If risk factors present, repeat eGFR and UACR annually 2
• If no risk factors present, routine screening per standard preventive care guidelines is sufficient 2

If UACR 30-299 mg/g (Moderately Increased Albuminuria):

• Diagnose CKD Stage 2 (G2A2) 2
• Target blood pressure <130/80 mmHg 2
• Initiate ACE inhibitor or ARB if hypertension is present 2
• Initiate statin therapy for cardiovascular risk reduction 2
• Monitor eGFR and UACR every 6-12 months 2
• Investigate underlying causes: optimize glucose control if diabetic, assess for glomerulonephritis if hematuria present 2

If UACR ≥300 mg/g (Severely Increased Albuminuria):

• Diagnose CKD Stage 2 (G2A3) - high risk for progression 2
• Initiate ACE inhibitor or ARB at maximum tolerated dose regardless of blood pressure 3, 2
• For patients with type 2 diabetes: initiate SGLT2 inhibitor (empagliflozin, canagliflozin, or dapagliflozin) as it reduces CKD progression by 30-40% 3
• Initiate statin therapy 2
• Monitor eGFR and UACR every 3-4 months 2
• Consider nephrology referral for continuously increasing albuminuria despite optimal management 2

Common Pitfalls to Avoid

• Do not diagnose CKD based on a single eGFR measurement alone - kidney damage markers (especially albuminuria) must be assessed 3, 1
• Do not rely on serum creatinine alone - it is affected by muscle mass, age, sex, diet, and medications independent of kidney function 1
• Do not assume normal kidney function excludes future CKD risk - patients with risk factors (diabetes, hypertension, family history) require ongoing surveillance even with normal baseline values 2
• Do not use urine dipstick for protein - UACR measurement is far more sensitive and specific for detecting clinically significant albuminuria 3

Special Considerations for Specific Populations

• Elderly patients (>60 years): An eGFR of 82 mL/min/1.73m² is well within normal range, but consider measuring cystatin C if eGFR were 45-59 mL/min/1.73m² to confirm true kidney function, as creatinine-based equations may overestimate GFR in elderly patients with low muscle mass 3, 4
• Diabetic patients: Screen annually with both eGFR and UACR starting at diagnosis for type 2 diabetes or 5 years after diagnosis for type 1 diabetes 3, 2
• Patients with cardiovascular disease: Even without CKD, these patients benefit from blood pressure control <130/80 mmHg and statin therapy 2