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A 40 year old woman comes to you after she was found to have a reading of 2+ on a dipstick proteinuria test at an insurance company medical examination. She is fit and well with no major medical history or family history of illness. She has no urinary symptoms and no oedema. She is not pregnant.

Chronic kidney disease (CKD) describes abnormal kidney function or structure. It is often asymptomatic (and unrecognized) and commonly occurs in the context of other chronic diseases such as diabetes and cardiovascular disease (CVD). It is associated with an increased risk of mortality and a small, but significant percentage of people with CKD progress to end-stage renal failure. Patients with CKD have an increased risk of CVD and are much more likely to die from a CVDrelated cause than they are to progress to end-stage renal disease. There is evidence that treatment can delay the progression of CKD and reduce the associated risk of CVD. The combination of a condition that is common in primary care with evidence that treatment can reduce disease progression and the risk of associated complications make CKD an important topic for general practitioners (GPs). It is, however, not without controversy — there are significant disagreements within the nephrological community, particularly around the significance of milder stages of CKD and the effect of normal ageing, and this in part has contributed to confusion for many GPs.

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