Chronic kidney disease

Last reviewed: 24 Apr 2022
Last updated: 08 Dec 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fatigue
  • oedema
  • nausea with/without vomiting
  • pruritus
  • restless legs
  • anorexia
  • infection-related glomerular disease
More key diagnostic factors

Other diagnostic factors

  • arthralgia
  • enlarged prostate gland
  • foamy-appearing urine
  • cola-coloured urine
  • rashes
  • dyspnoea
  • orthopnoea
  • seizures
  • retinopathy
Other diagnostic factors

Risk factors

  • diabetes mellitus
  • hypertension
  • age >50 years
  • childhood kidney disease
  • smoking
  • obesity
  • black or Hispanic ethnicity
  • family history of CKD
  • autoimmune disorders
  • male sex
  • long-term use of non-steroidal anti-inflammatory drugs
  • high uric acid levels
More risk factors

Diagnostic investigations

1st investigations to order

  • renal chemistry
  • estimation of GFR
  • serum cystatin C and cystatin C-based estimation of GFR
  • urinalysis
  • urinary albumin
  • renal ultrasound
More 1st investigations to order

Investigations to consider

  • kidney biopsy
  • plain abdominal radiograph
  • abdominal CT
  • abdominal MRI
More investigations to consider

Treatment algorithm

ACUTE

GFR category G1 to G2 without uraemia

GFR category G3 to G4 without uraemia

GFR category G5 or with uraemia

Contributors

Authors

Manisha Singh, MD
Manisha Singh

Associate Professor

Division of Nephrology

Department of Internal Medicine

Director Home Dialysis Program

Co-Director M2 Renal Module

University of Arkansas for Medical Sciences

Little Rock

AR

Disclosures

MS is an author of a reference cited in this topic.

Michelle W. Krause, MD, MPH
Michelle W. Krause

Professor of Medicine

Director, Integrated Medicine Service Line

Vice-Chair for Clinical Operations, Quality, and Efficiency

Department of Internal Medicine

University of Arkansas for Medical Sciences

Central Arkansas Veterans Healthcare System

Little Rock

AR

Disclosures

MWK declares that she has no competing interests.

Acknowledgements

Dr Manisha Singh and Dr Michelle Krause would like to gratefully acknowledge Professor Sudhir V. Shah, a previous contributor to this topic.

Disclosures

SVS declares that he has no competing interests.

Peer reviewers

Robert Toto, MD

Professor

Internal Medicine - Nephrology

Southwestern Medical School

The University of Texas Southwestern Medical Center at Dallas

Dallas

TX

Disclosures

RT declares that he has no competing interests.

Guy H. Neild, MD, FRCP, FRCPath

Professor of Nephrology

UCL Division of Medicine

University College London

London

UK

Disclosures

GHN declares that he has no competing interests.

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