Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • hypertension (HTN)
  • signs of retinopathy
  • edema

Other diagnostic factors

  • poor vision
  • numbness of the lower extremities
  • pain of the lower extremities
  • constitutional symptoms (advanced disease)
  • foot changes
  • orthostatic hypotension
  • skin changes
  • muscular atrophy
  • pallor (as GFR declines)
  • bleeding tendency (advanced disease)
  • Kussmaul respirations (advanced disease)

Risk factors

  • sustained hyperglycemia
  • hypertension (HTN)
  • FHx of HTN and/or kidney disease
  • obesity
  • smoking
  • physical inactivity
  • dyslipidemia
  • high protein, fat, and sodium intake

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urinary albumin to creatinine ratio (ACR)
  • blood biochemistry
  • serum creatinine with GFR estimation
  • kidney ultrasound
Full details

Investigations to consider

  • 24-hour urine collection
  • CT abdomen
  • magnetic resonance angiography
  • Doppler ultrasound
  • kidney biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

David J. Leehey

Professor of Medicine

Division of Nephrology

Loyola University Medical Center

Maywood

IL

Associate Chief of Staff for Clinical Affairs and Education

Veterans Affairs Hospital

Hines

IL

Disclosures

DJL declares that he has no competing interests.

Irfan Moinuddin

Assistant Professor of Medicine

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

IM declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Department of Medicine

Division of Nephrology

Indiana University School of Medicine

Indianapolis

IN

Disclosures

RA declares that he has no competing interests.

Associate Professor

Baker IDI Heart and Diabetes Institute

Melbourne

Australia

Disclosures

MCT has received honoraria for speaking and educational sessions conducted by Sanofi-Aventis, Servier, Boehringer-Ingleheim, Abbott, Amgen, and Jansen-Cilag.

Consultant/Senior Lecturer in Renal Medicine

Belfast City Hospital and Queen's University Belfast

Belfast City Hospital

Belfast

Northern Ireland

UK

Disclosures

DF has no share options, research support, or employment with pharmaceutical companies. He has received one-time speaking fees to cover his time preparing educational talks in the broad areas of diabetic nephropathy and chronic kidney disease, promoting early recognition and evidence-based or best practice management.

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