Last reviewed: 7 Feb 2021
Last updated: 02 Jul 2020



History and exam

Key diagnostic factors

  • fatigue
  • edema
  • nausea with/without vomiting
  • pruritus
  • restless legs
  • anorexia
  • infection-related glomerular disease

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

1st investigations to order

  • renal chemistry
  • estimation of GFR
  • serum cystatin C and cystatin C-based estimation of GFR
  • urinalysis
  • urinary albumin
  • renal ultrasound

Investigations to consider

  • kidney biopsy
  • plain abdominal radiograph
  • abdominal CT
  • abdominal MRI

Treatment algorithm


Manisha Singh

Assistant 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



MS has received a Baxter Grant and NKF grant to study chronic kidney disease education and other efforts.

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



MWK declares that she has no competing interests.

Dr Manisha Singh and Dr Michelle Krause would like to gratefully acknowledge Professor Sudhir V. Shah, a previous contributor to this topic. SVS declares that he has no competing interests.

Peer reviewersVIEW ALL


Internal Medicine - Nephrology

Southwestern Medical School

The University of Texas Southwestern Medical Center at Dallas




RT declares that he has no competing interests.

Professor of Nephrology

UCL Division of Medicine

University College London




GHN declares that he has no competing interests.

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