Urological footprint of chronic kidney disease: A nephrologist perspective on early detection and collaborative management

Table 6 Stage-based nephro-urological management pathway in chronic kidney disease

CKD stage	Routine urological screening	Referral triggers	Co-management goals
Stage 1-2 (early CKD)	(1) Urinalysis (proteinuria, hematuria); (2) Kidney/bladder ultrasound; and (3) History of LUTS, recurrent UTIs, stone disease	(1) Recurrent UTIs; (2) Hematuria not explained by nephrology; and (3) Suspected obstruction (hydronephrosis, poor bladder emptying)	(1) Identify and treat reversible urological causes early; and (2) Prevent progression of CKD
Stage 3-4 (moderate CKD)	(1) Post-void residual measurement Uroflowmetry if LUTS present; and (2) Stone risk assessment (metabolic work-up)	(1) Persistent LUTS despite medical therapy; and (2) Recurrent stones Obstructive uropathy on imaging	(1) Slow CKD progression; (2) Prevent recurrent infections and obstruction; and (3) Optimize bladder function
Stage 5 (ESKD, pre-dialysis)	(1) Focused urological history and exam; and (2) Imaging for obstruction if symptoms/signs present	(1) Hydronephrosis or ureteral stricture; and (2) Severe LUTS impacting quality of life	(1) Prepare for renal replacement therapy; and (2) Ensure unobstructed urinary tract before transplant
Dialysis-dependent	(1) Catheter/vascular access infection surveillance; and (2) Bladder function assessment in long-term dialysis	(1) Recurrent UTIs or urosepsis; and (2) Catheter-related complications	(1) Prevent infection; (2) Manage bladder dysfunction; and (3) Maintain quality of life

CKD: Chronic kidney disease; ESKD: End-stage kidney disease; LUTS: Lower urinary tract symptoms; UTI: Urinary tract infection.