Table 10.2-1. Diagnostic criteria for CKD according to the 2012 KDIGO guideline

Criterion

Comment

1. Duration >3 months

Necessary for diagnosis of CKD

2a. GFR <60 mL/min/1.73 m2 (CKD categories G3a-G5)

eGFR (mL/min/1.73 m2) calculated with equationsa using SCr:

1) CKD-EPI creatinine equation:

eGFR = 141 × min(SCr/κ, 1)α × max(SCr/κ, 1)−1.209 × 0.993age × 1.018 [if female] × 1.159 [if black]

Where:

SCr = serum creatinine in mg/dL

κ = 0.7 for females and 0.9 for males

α = −0.329 for females and −0.411 for males

min = the minimum of SCr/κ or 1

max = the maximum of SCr/κ or 1

2) Abbreviated MDRD equation:

eGFR = 186 × [SCr]−1.154 × [age]−0.203 × [0.742 if female] × [1.21 if black]

Where:

SCr = serum creatinine level

2b. Albuminuria or proteinuria (albuminuria categories: Table 10.2-3)

– Urine albumin excretion ≥30 mg/d, or

– Albumin-to-creatinine ratio ≥30 mg/mmol

2c. Urine sediment abnormalities

– Isolated microscopic hematuria with dysmorphic RBCs

– RBC casts, WBC casts, fatty casts, granular casts, or renal tubular epithelial cells

2d. Renal tubular disorders

Renal tubular acidosis, nephrogenic diabetes insipidus, renal potassium and magnesium wasting, Fanconi syndrome, cystinuria, nonalbumin proteinuria

2e. Structural abnormalities detected by imaging

Polycystic kidneys,b dysplastic kidneys, hydronephrosis due to obstruction, cortical scarring due to infarcts, pyelonephritis or vesicoureteral reflux, renal masses or infiltrative diseases, renal artery stenosis, small hyperechoic kidneys (commonly revealed by ultrasonography in severe CKD due to many parenchymal diseases)

2f. Pathologic abnormalities detected by histology or inferred

– Glomerular diseases (glomerulonephritis, diabetes mellitus, autoimmune diseases, amyloidosis, systemic infections, drugs, neoplasia)

– Vascular diseases (atherosclerosis, hypertension, ischemia, vasculitis, thrombotic microangiopathy, cholesterol embolism)

– Tubulointerstitial diseases (urinary tract infections, stones, obstruction, sarcoidosis, drug toxicity, environmental toxins)

– Cystic and congenital diseases (Alport syndrome, Fabry disease)

2g. History of kidney transplantation

In most patients biopsies of transplanted kidneys reveal abnormalities even with GFR >60 mL/min/1.73m2 and no albuminuria

To meet the CKD criteria, a duration >3 months and any of 2a to 2g are required.

a Online calculator for both equations at www.kidney.org.

b Simple renal cysts are not a criterion for diagnosing CKD.

Based on Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter., Suppl. 2012; 2: 1-138.

CKD, chronic kidney disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; eGFR, estimated glomerular filtration rate; GFR, glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes; MDRD, Modification of Diet in Renal Disease; PCr, plasma creatinine level; RBC, red blood cell; SCr, serum creatinine level; WBC, white blood cell.