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CKD Diagnosis — ESENeph MCQ

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ModerateChronic Kidney DiseaseCKD DiagnosisESENeph

A 42-year-old woman has a creatinine of 68 umol/L, giving an eGFR of 88 mL/min/1.73m2 by CKD-EPI creatinine. She has a BMI of 18, is vegetarian, and has significant muscle wasting from chronic illness. Cystatin C is measured giving eGFR-cys of 52 mL/min/1.73m2. Which eGFR should guide clinical decision-making?

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Correct answer: C — eGFRcr-cys (combined creatinine and cystatin C equation)

KDIGO 2024 recommends using eGFRcr-cys (combined equation) when cystatin C is available and when eGFRcr may be inaccurate (1B). In patients with extremes of muscle mass, diet, or body composition, creatinine alone may overestimate true GFR. The combined equation provides greater accuracy. Where there is significant discordance and the result would change management, formal measured GFR (iohexol/inulin clearance) may be indicated.

Reference: KDIGO 2024 – Clinical Practice Guideline for CKD