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Chronic kidney disease

Última revisão: 13 Sep 2025
Última atualização: 22 Aug 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • fatigue
  • edema
  • nausea with/without vomiting
  • pruritus
  • skin and nail changes
  • restless legs
  • anorexia
  • infection-related glomerular disease
Detalhes completos

Outros fatores diagnósticos

  • arthralgia
  • enlarged prostate gland
  • foamy-appearing urine
  • cola- or tea-colored urine
  • rashes
  • dyspnea
  • orthopnea
  • seizures
  • retinopathy
Detalhes completos

Fatores de risco

  • diabetes mellitus
  • hypertension
  • age >50 years
  • childhood kidney disease
  • smoking
  • obesity
  • non-Hispanic black ethnicity
  • family history of CKD
  • autoimmune disorders
  • male sex
  • long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • high uric acid levels
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • renal chemistry
  • estimation of GFR using serum creatinine
  • estimation of GFR using cystatin C with or without serum creatinine
  • urinalysis
  • urinary albumin
  • renal ultrasound
Detalhes completos

Investigações a serem consideradas

  • kidney biopsy
  • plain abdominal radiograph
  • diabetes screen
  • mineral bone disorder assessment
  • anemia assessment
Detalhes completos

Novos exames

  • genetic testing

Algoritmo de tratamento

AGUDA

GFR category G1 to G2

GFR category G3 to G4

GFR category G5

Colaboradores

Autores

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

Divulgaciones

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

Divulgaciones

MWK declares that she has no competing interests.

Agradecimientos

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

Divulgaciones

SVS declares that he has no competing interests.

Revisores por pares

Robert Toto, MD

Professor

Internal Medicine - Nephrology

Southwestern Medical School

The University of Texas Southwestern Medical Center at Dallas

Dallas

TX

Divulgaciones

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

Divulgaciones

GHN declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024 Apr;105(4s):S117-314.Texto completo  Resumen

National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].Texto completo

Wong-You-Cheong JJ, Nikolaidis P, Katri G, et al; Expert Panel on Urologic Imaging. ACR appropriateness criteria® renal failure. J Am Coll Radiol. 2021 May;18(5s):S174-88.Texto completo  Resumen

Kalantar-Zadeh K, Jafar TH, Nitsch D, et al. Chronic kidney disease. Lancet. 2021 Aug 28;398(10302):786-802. Resumen

Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017 Jul;7(1):1-59.Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Diferenciales

    • Acute kidney injury
    • Diabetic kidney disease
    • Hypertensive nephrosclerosis
    Más Diferenciales
  • Guías de práctica clínica

    • KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease
    • Chronic kidney disease and risk management: standards of care in diabetes - 2024
    Más Guías de práctica clínica
  • Folletos para el paciente

    Chronic kidney disease: what is it?

    Chronic kidney disease: what are the treatment options?

    Más Folletos para el paciente
  • Calculadoras

    Glomerular Filtration Rate Estimation (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Equation with Creatinine, without Race (2021)

    Glomerular Filtration Rate Estimation (eGFR) by CKD-EPI Equation with Cystatin C, without Race (2012)

    Más Calculadoras
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Más vídeos
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