Chronic kidney disease (CKD) is a common condition that is often unrecognised until the most advanced stages.
Diagnosis is determined only by laboratory studies: proteinuria or haematuria, and/or a reduction in the glomerular filtration rate, for more than 3 months' duration.
The most common causes are diabetes mellitus and hypertension.
Glycaemic control for diabetic kidney disease and optimisation of blood pressures are key in slowing the progression of the disease. Use of agents that block the renin-angiotensin system and sodium-glucose co-transporter 2 inhibitors have kidney function preserving benefits that are independent of blood pressure and glucose control.
CKD is a risk factor for cardiovascular disease, independent of comorbidities such as diabetes, hypertension, and dyslipidaemia.
Chronic kidney disease (CKD), also known as chronic renal failure, is defined as abnormalities of kidney structure or function, present for ≥3 months, with implications for health. This means a glomerular filtration rate less than 60 mL/minute/1.73 m², or the presence of one or more of the following markers of kidney damage: albuminuria/proteinuria, urine sediment abnormalities (e.g., haematuria), electrolyte abnormalities due to tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging, or history of kidney transplantation.
History and exam
Key diagnostic factors
- presence of risk factors
- nausea with/without vomiting
- restless legs
- infection-related glomerular disease
Other diagnostic factors
- enlarged prostate gland
- foamy-appearing urine
- cola-coloured urine
- diabetes mellitus
- age >50 years
- childhood kidney disease
- 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
1st investigations to order
- renal chemistry
- estimation of GFR
- serum cystatin C and cystatin C-based estimation of GFR
- urinary albumin
- renal ultrasound
Investigations to consider
- kidney biopsy
- plain abdominal radiograph
- abdominal CT
- abdominal MRI
GFR category G1 to G2 without uraemia
GFR category G3 to G4 without uraemia
GFR category G5 or with uraemia
- Diabetic kidney disease
- Hypertensive nephrosclerosis
- Ischaemic nephropathy
- Clinical practice guideline: exercise and lifestyle in chronic kidney disease
- KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease
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