Table 6.2-2. CKD stages in diabetic nephropathy

 

eGFR categories

(mL/min/1.73 m2)a

Albuminuria categories

(urine ACR/24 h)

A1 (normal):

<2 mg/mmol or

<30 mg/24 h

A2 (microalbuminuria):

2-20 mg/mmol or

30-300 mg/24 h

A3 (overt nephropathy):

>20 mg/mmol or >300 mg/24 h

G1b,d

Normal eGFR

(>90)

 

Treat

Treat

G2b,d

Mildly ↓ eGFR

(60-89)

 

Treat

Treat

G3ac,d

Moderately ↓ eGFR

(45-59)

Treat

Treat

Consider referral

G3bc,d

Moderately ↓ eGFR

(30-44)

Treat

Treat

Consider referral

G4c,d

Severely ↓ eGFR

(15-29)

Consider referral

Consider referral

Refer

G5c,d

End-stage renal failure

(<15)

Refer

Refer

Refer

Risk of CKD progression:

green, low risk; yellow, caution with close observation needed; orange, moderately increased risk; red, high risk, nephrology referral should be considered; dark red, very high risk, nephrology referral should be made.

a Focus on kidney-related care: Diagnose the cause of kidney injury in G1 to G3, evaluate and treat risk factors for CKD progression in G1 to G4, evaluate and treat CKD complications in G3 to G5, and prepare for renal replacement therapy in G4 and G5.

For any CKD stage the degree of albuminuria, observed history of eGFR decrease, and cause of kidney damage (including possible causes other than DM) may also be used to characterize CKD, evaluate prognosis, and guide treatment decisions.

b G1 and G2 are characterized by evidence of kidney damage.

c G3 to G5 are defined by reduced eGFR with or without evidence of kidney damage.

d Kidney damage most often manifests as albuminuria (urine ACR >30 mg/g), but it can also be associated with glomerular hematuria, other abnormalities of urinary sediment, radiographic abnormalities, and other presentations.

Adapted from Diabetes Care. 2020;43(suppl. 1):S135-S151 and Can J Diabetes. 2018;42:S201-S209.

↓, decreased; ACR, albumin to creatinine ratio, CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate.