Nephrology · Decision Helper · Kidney Tests

Which Kidney Test Do You Need?

A short, plain-language decision helper. Answer a few questions and it points you to the right rung of the kidney-test ladder — creatinine + eGFR for most people, cystatin C when the marker may mislead, measured GFR for high-stakes decisions, and an urgent-assessment flag when you are acutely ill. It never diagnoses and never tells you to start or stop a medicine.

Published: References: 3 Read time:

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Instructions
  1. Work through the four questions below. Tick every box that applies — you can leave a whole group blank if none fit.
  2. Press Show my recommendation. The helper reads your answers in priority order (acute illness first) and names the most appropriate test.
  3. Bring the recommendation to your clinician — it is a starting point for the conversation, not an order or a diagnosis.

Everything runs in your browser. No answers are stored or transmitted.

What this helper does — and does not — do

What it does

It maps your situation onto the KDIGO-aligned kidney-test ladder: serum creatinine + estimated GFR (eGFR) for routine assessment; adding cystatin C for a combined estimate (eGFRcr-cys) when creatinine may mislead or a decision is close to a threshold; a measured GFR (mGFR) for high-stakes decisions; and it flags acute situations where a steady-state eGFR should not be trusted at all. It also reminds you that a urine albumin-to-creatinine ratio (uACR) belongs alongside filtration testing.

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What it does not do

It does not calculate a GFR, does not diagnose chronic kidney disease, does not assign a "percent kidney function," and never advises starting or stopping any medicine. Special situations — pregnancy, childhood, kidney-donor evaluation, or dosing a narrowly toxic drug — are routed to a clinician pathway rather than answered by a web tool.

Answer four questions.

Tick everything that applies. The most urgent or highest-precision answer wins — and the helper always reminds you to pair filtration testing with a urine albumin check.

1 Are you acutely unwell right now?
During rapidly changing kidney function, a steady-state eGFR can lag far behind your real filtration.
2 Do any of these special situations apply?
These need a dedicated pathway — the ordinary adult eGFR equations are not the right tool.
3 Could your creatinine be misleading — or is a decision close to a threshold?
Creatinine tracks muscle and diet as well as filtration, so these can throw it off.
4 Do both markers seem unreliable, or is very high accuracy essential?
When even a combined estimate may fall short and the stakes are high, a measured GFR is the next step.

The kidney-test ladder, in one screen.

Every recommendation this helper gives is a rung on the same ladder. You climb it only when a lower rung might mislead, or when a decision is important enough to justify more accuracy.

1 Serum creatinine — a measured blood marker, influenced by more than filtration.
2 eGFR from creatinine — an estimate; the right first test for most adults.
3 eGFR from creatinine + cystatin C — usually the best routine estimate when a marker may mislead.
4 Measured GFR — clearance of an injected filtration marker; for high-stakes decisions.
+ Urine ACR — a separate axis (kidney damage), not a way of measuring GFR. Runs alongside all of the above.

Read the full guide → for the physiology, the equations, the uncertainty behind every eGFR, and the two-axis (filtration + damage) model.

References 3 sources
  1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4S), S117–S314. https://doi.org/10.1016/j.kint.2023.10.018
  2. Inker, L. A., Eneanya, N. D., Coresh, J., Tighiouart, H., Wang, D., Sang, Y., ... & Levey, A. S. (2021). New creatinine- and cystatin C–based equations to estimate GFR without race. New England Journal of Medicine, 385(19), 1737–1749. https://doi.org/10.1056/NEJMoa2102953
  3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2025). Estimating glomerular filtration rate (eGFR) and factors affecting eGFR accuracy in adults. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/research-funding/research-programs/kidney-clinical-research-epidemiology/laboratory/glomerular-filtration-rate-equations/adults
Dr. W Rivero, MD

W Rivero, MD, FPCP, DPSN

Specialist in Internal Medicine, Nephrology, and Clinical Nutrition. Practicing integrative and evidence-based nephrology across Quezon City, Pampanga, and Bulacan.

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