KFRE Prognosis Counselling — ESENeph MCQ

Correct answer: B — Evaluate the unexpected eGFR fall

The best answer is “Evaluate the unexpected eGFR fall”. KDIGO considers an eGFR change greater than 20% on a subsequent test beyond expected variability. The clinician confirms the result and assesses volume, acute illness, obstruction, nephrotoxins and other causes. “It proves irreversible CKD progression from two values alone” is less appropriate because acute illness, haemodynamics, medication and laboratory variation must be assessed before attributing chronic progression “It is within expected variability and needs no follow-up” is less appropriate because KDIGO identifies a change greater than 20% as exceeding expected variability “It mandates immediate dialysis initiation” is less appropriate because the percentage change does not establish a dialysis indication “It should be ignored if albuminuria is unchanged” is less appropriate because a significant GFR change remains clinically important even without an ACR change

Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf