Background: Chronic Kidney Disease (CKD) is a progressive condition that requires comprehensive monitoring to prevent further decline in kidney function. This study investigates the role of imaging and laboratory markers in monitoring CKD progression and evaluates the impact of pharmacological interventions. Methods: A retrospective cohort study was conducted in a tertiary hospital involving 200 CKD patients. Laboratory markers (eGFR, creatinine) and imaging (ultrasound, MRI) were used to assess CKD progression. Pharmacological treatments, including ACE inhibitors, ARBs, and SGLT2 inhibitors, were analyzed for their effectiveness in slowing disease progression. Results: Significant correlations were found between eGFR decline and kidney size reduction (r = 0.68, p < 0.001). Patients treated with SGLT2 inhibitors had a slower eGFR decline (1.3 mL/min/1.73 m²/year) compared to those on ACE inhibitors/ARBs (2.5 mL/min/1.73 m²/year). Imaging revealed structural changes, with 65% of patients experiencing kidney size reduction and 45% showing increased fibrosis. Pharmacist-led interventions improved treatment adherence and reduced complications. Conclusion: Integrating laboratory markers with imaging provides a comprehensive assessment of CKD progression. SGLT2 inhibitors significantly slowed disease progression, and pharmacist involvement enhanced patient outcomes, underscoring the importance of a multidisciplinary approach to CKD management.