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Rapid CKD Progression Investigation — ESENeph MCQ

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ModerateChronic Kidney DiseaseRapid CKD Progression InvestigationESENeph

A 60-year-old man with CKD G3b has been stable for 3 years. His latest eGFR shows a decline from 38 to 28 mL/min/1.73m2 over 12 months (>5 mL/min/year decline). He is on Ramipril, Dapagliflozin, and Atorvastatin. What does this rate of decline indicate?

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Correct answer: C — Rapid CKD progression (>5 mL/min/1.73m2/year); requires investigation for superimposed causes and intensification of management

A decline of >5 mL/min/1.73m2/year is considered rapid CKD progression. KDIGO 2024 recommends investigating for superimposed causes: urinary obstruction, new nephrotoxin exposure, uncontrolled hypertension, disease flare (if GN), renal artery stenosis, or malignancy. Management intensification includes ensuring all guideline-directed therapies are optimised, addressing modifiable risk factors, and considering referral to nephrology if not already under specialist care. Confirm the decline with repeat testing to exclude laboratory error.

Reference: KDIGO 2024 – CKD Guideline