76 year old male with stage 3A based on an estimated glomerular filtration rate of 55 mL/min/1.73 m2. A urinalysis in your office is normal, with no hematuria or proteinuria.
How should you treat this patient? Answer: Reassurance and observation
“Chronic kidney disease appears to be overdiagnosed in the older population. Stage 3A kidney disease is defined as an estimated glomerular filtration rate (GFR) of 45–59 mL/min/1.73 m2 and is predominantly seen in older patients. It is seldom progressive in the absence of significant proteinuria. Older patients with chronic kidney disease are less likely to develop end-stage renal disease than to die of complications related to aging and cardiovascular disease. There is a decline in estimated GFR with normal aging, and the likelihood of patients progressing to end-stage renal disease and dialysis is minimal if they have a GFR of 45–59 mL/min/1.73 m2.” ABFM
Reference
An age-calibrated classification of chronic kidney disease. JAMA 2015;314(6):559-560. http://jamanetwork.com/journals/jama/article-abstract/2300875
https://www.ncbi.nlm.nih.gov/pubmed/26023760