Question 1

How often should eGFR and ACR be rechecked based on staging?

Accepted Answer

Low risk (G1A1, G2A1): annually. Moderate risk: every 6 months. High risk: every 3–6 months. Very high risk: every 1–3 months or as clinically indicated. More frequent monitoring if the patient is on nephrotoxic medications or has a progressive aetiology.

Question 2

When should I refer to a nephrologist?

Accepted Answer

Refer for eGFR <30 (G4–G5), ACR >300 (A3), rapid progression (decline in eGFR >5 mL/min/1.73m²/year), uncontrolled hypertension despite ≥3 agents, or when the cause of CKD is uncertain.

Question 3

How is the staging used in medication safety?

Accepted Answer

Many medications require dose adjustment or avoidance at specific G stages (e.g., metformin is contraindicated at G4–G5, NSAIDs should be avoided at G3b or below). The A category adds prognostic information but does not directly alter drug dosing thresholds.

Question 4

Does G1A1 count as CKD if there are no structural abnormalities?

Accepted Answer

CKD is defined by eGFR <60 (G3–G5) OR markers of kidney damage (including A2–A3) for ≥3 months. A patient with G1A1 with normal urinalysis and normal imaging does not meet CKD criteria. However, G1A1 with a structural abnormality (e.g., polycystic kidneys) does qualify as CKD.