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Last reviewed: 24 Sep 2025
Last updated: 22 Aug 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fatigue
  • oedema
  • nausea with/without vomiting
  • pruritus
  • skin and nail changes
  • restless legs
  • anorexia
  • infection-related glomerular disease

Other diagnostic factors

  • arthralgia
  • enlarged prostate gland
  • foamy-appearing urine
  • cola- or tea-coloured urine
  • rashes
  • dyspnoea
  • orthopnoea
  • seizures
  • retinopathy

Risk factors

  • 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 non-steroidal anti-inflammatory drugs (NSAIDs)
  • high uric acid levels

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • kidney biopsy
  • plain abdominal radiograph
  • diabetes screen
  • mineral bone disorder assessment
  • anaemia assessment

Treatment algorithm

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

Declarações

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

Declarações

MWK declares that she has no competing interests.

Agradecimentos

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

Declarações

SVS declares that he has no competing interests.

Revisores

Robert Toto, MD

Professor

Internal Medicine - Nephrology

Southwestern Medical School

The University of Texas Southwestern Medical Center at Dallas

Dallas

TX

Declarações

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

Declarações

GHN declares that he has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

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  Resumo

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  Resumo

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

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

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível aqui.

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