Pathways and Stages Kidney disease pathway hematuria pathway diabetes pathway non-diabetic MRP CKD stages referral sheet
    Disclaimer: The information and data in this document ("Information") is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.

Using GFR

a. – eGFR < 60 ml/min/1.73m2

eGFR derived by the MDRD equation has become the standard to assess kidney function in most adult outpatients with stable CKD. eGFR outperforms 24 hour urine collection and/or measured GFR in diagnosis and prognostication.

Manitoba Renal Program Recommendations:

  • If eGFR is reported as < 60 ml/min/1.73m2, it should be repeated to ensure it is not declining rapidly, and again after 3 months to determine if persistent, or chronic. This should also be accompanied by a urinalysis and estimation of protein excretion rate to calculate each individual’s risk of CKD progression.
  • Patients are deemed to have CKD if there are abnormalities of kidney imaging, urinalysis, or function (eGFR < 60 ml/min/1.73m2) for greater than 3 months.
  • Routine urinalysis and an estimate of protein excretion rate should be done to help guide diagnosis, management, and predict risk of progression of CKD.
  • eGFR only provides information about the degree but not the cause of kidney impairment; further assessment of urinary sediment, protein excretion rate, and imaging, is required. Determining whether a patient has CKD should not be based on eGFR in isolation.
  • eGFR should be used with caution in the very  elderly, and those with extreme body composition (i.e. amputations, very obese or lean) and pregnancy. eGFR may under- or overestimate the true GFR with any of these variables.
  •  eGFR requires a correction/conjugation for African American ethnicity. In these patients, eGFR should be multiplied by 1.21.
  • Drugs that inhibit the tubular secretion of creatinine (i.e. trimethoprim, fibric acid derivatives other than gemfibrozil) can affect the accuracy of eGFR
  • eGFR should not be used in patients with acute kidney injury.
  • Nephrology referral should be considered for eGFR < 60/ml/min  or/and proteinuria per criteria outlined in the MRP Kidney Disease Referral Pathway.