Chronic kidney disease
Summary
Definition
History and exam
Key diagnostic factors
- fatigue
- edema
- 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-colored urine
- rashes
- dyspnea
- orthopnea
- 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 nonsteroidal anti-inflammatory drugs (NSAIDs)
- high uric acid levels
Diagnostic tests
1st tests 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
Tests to consider
- kidney biopsy
- plain abdominal radiograph
- diabetes screen
- mineral bone disorder assessment
- anemia assessment
Emerging tests
- genetic testing
Treatment algorithm
GFR category G1 to G2
GFR category G3 to G4
GFR category G5
Contributors
Authors
Manisha Singh, MD
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
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.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
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 DiferencialesGuías de práctica clínica
- Chronic kidney disease and risk management: standards of care in diabetes - 2025
- KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease
Más Guías de práctica clínicaFolletos para el paciente
Chronic kidney disease: what is it?
Chronic kidney disease: what are the treatment options?
Más Folletos para el pacienteCalculadoras
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 CalculadorasVideos
Venepuncture and phlebotomy: animated demonstration
Más vídeos
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad