Chronic kidney disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 11 Dec 2025

Last updated: 14 Nov 2025

Chronic kidney disease (CKD) is a common condition that is often unrecognized until the most advanced stages.

Diagnosis is determined by laboratory studies: proteinuria or hematuria, and/or a reduction in the glomerular filtration rate, of more than 3 months' duration.

Comorbidity is common and should always be considered in the diagnosis and management of people with CKD. Diabetes mellitus and hypertension are the most common causes of CKD and the most common comorbidities associated with CKD; they both lead to and complicate CKD.

Glycemic control for diabetic kidney disease and optimization of blood pressure are key in slowing the progression of the disease. Use of agents that block the renin-angiotensin system and sodium-glucose cotransporter-2 (SGLT2) 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 dyslipidemia.

Definition

CKD, also known as chronic renal failure, is defined as abnormalities of kidney structure or function, present for ≥3 months, with implications for health.[1] In practice, 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 (albumin to creatinine ratio [ACR] ≥30 mg/g), urine sediment abnormalities, persistent hematuria, electrolyte and other abnormalities due to tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging, or history of kidney transplantation.[1]

BMJ talk medicine: chronic kidney disease Opens in new window

History and exam

Key diagnostic factors

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

Full details

Other diagnostic factors

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

Full details

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

Full details

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

Full details

Tests to consider

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

Full details

Emerging tests

genetic testing

Treatment algorithm

ACUTE

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

Declarações

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

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

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

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 para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Acute kidney injury
- Diabetic kidney disease
- Hypertensive nephrosclerosis
Mais Diagnósticos diferenciais
Diretrizes
- 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
Mais Diretrizes
Folhetos informativos para os pacientes
Chronic kidney disease: what is it?
Chronic kidney disease: what are the treatment options?
Mais Folhetos informativos para os pacientes
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)
Mais Calculadoras
Videos
Venepuncture and phlebotomy: animated demonstration
Mais vídeos
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Chronic kidney disease

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

GFR category G1 to G2

GFR category G3 to G4

GFR category G5

Contributors

Authors

Manisha Singh, MD

Declarações

Michelle W. Krause, MD, MPH

Declarações

Agradecimentos

Declarações

Revisores

Robert Toto, MD

Declarações

Guy H. Neild, MD, FRCP, FRCPath

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Calculadoras

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice