a. We check details recommend that CKD be diagnosed in all individuals on at least two occasions for a period of at least 3 months, irrespective of the underlying cause and on the basis of: (1C) an estimated or measured GFR <60 mL/min per 1.73 m2 and/or evidence of kidney damage (albuminuria, proteinuria, haematuria after exclusion of urological causes, or structural abnormalities on kidney imaging tests) Note: These diagnostic criteria are the same for all races and gender. b. We recommend that the stages of CKD should be based on the combined indices of kidney function (measured

or estimated GFR) (Table 2) and kidney damage (albuminuria/proteinuria) (Table 3), irrespective of the underlying diagnosis (1C). The following diagnostic evaluation tests for CKD are always indicated: Full blood count Repeat (within 1 week) serum urea/electrolytes/creatinine/eGFR/albumin Urine ACR (preferably Napabucasin mw on a first morning void, although a random urine is acceptable) Fasting lipids and glucose Urine microscopy and culture Renal ultrasound scan The following diagnostic evaluation tests for CKD are sometimes indicated: If patient: Then carry out the following test: Has diabetes HbA1C Has eGFR <60 mL/min per 1.73 m2 Serum calcium, phosphate, PTH, 25-hydroxy-vitamin D and iron studies Is >40 years old Serum and urine electrophoresis Has rash, arthritis or features of connective tissue disease Anti-nuclear antibodies, Extractable nuclear antigens, Complement studies

Has pulmonary symptoms or deteriorating kidney function Anti-glomerular basement membrane antibody, Anti-neutrophil cytoplasmic

antibody Has risk factors for HBV, HCV and HIV HBV, HCV, HIV serology Has persistent albuminuria >60–120 mg/mmol (approximately equivalent to 24 h urinary protein >1–2 g/day) Refer to Nephrologist for consideration of renal biopsy We recommend referral to a specialist renal service or nephrologist in the following situations: Stage 4 and 5 CKD of any cause (eGFR < 30 mL/min per 1.73 m2) (1C) Persistent significant albuminuria (ACR ≥ 30 mg/mmol, approximately equivalent to protein creatinine ratio (PCR) ≥50 mg/mmol, or urinary protein excretion ≥500 mg/24 h) (1C) A consistent decline Dynein in eGFR from a baseline of <60 ml/min per 1.73 m2 (a decline > 5 ml/min per 1.73 m2 over a 6-month period which is confirmed on at least three separate readings) (1C)* We suggest referral to a specialist renal service or nephrologist in the following situations: Glomerular haematuria with macroalbuminuria (2C) CKD and hypertension that is hard to get to target despite at least three anti-hypertensive agents (2C). We suggest discussing management issues with a specialist by letter, email or telephone in cases where it may not be necessary for the person with CKD to be seen by the specialist (2D). Once a referral has been made and a plan jointly agreed, routine follow-up could take place at the patient’s General Practitioner surgery rather than in a specialist clinic.