Chronic kidney disease
ICD-10 N18 · ICD-11 GB61

Treatment of CKD with Moderately or Severely Increased Albuminuria Without Diabetes

Clinical Scenario

This protocol addresses patients with chronic kidney disease who have a urine albumin-to-creatinine ratio (ACR) of 30–300 mg/g (moderately increased albuminuria) or above 300 mg/g (severely increased albuminuria), in the absence of diabetes.

Specific Population

Elevated albuminuria — whether in the moderately increased (ACR 30–300 mg/g) or severely increased (>300 mg/g) range — in a non-diabetic patient with CKD defines this distinct clinical sub-group. The degree of albuminuria is a key determinant of the treatment approach outlined in this protocol.

Treatment Approach (Partial)

The evidence-based approach involves initiating a renin-angiotensin-system inhibitor — either an ACE inhibitor or an angiotensin II receptor blocker — as the primary pharmacological intervention.

Full agent selection criteria, target dose guidance, monitoring parameters, and the complete management algorithm are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.kint.2023.10.018

  1. We recommend starting renin-angiotensin-system inhibitors (RASi) (angiotensin-converting enzyme inhibitor [ACEi] or angiotensin II receptor blocker [ARB]) for people with CKD and severely increased albuminuria (G1–G4, A3) without diabetes (1B).
  2. We suggest starting RASi (ACEi or ARB) for people with CKD and moderately increased albuminuria (G1–G4, A2) without diabetes (2C).
  3. RASi (ACEi or ARB) should be administered using the highest approved dose that is tolerated to achieve the benefits described because the proven benefits were achieved in trials using these doses.
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