Chronic kidney disease

Last reviewed: 23 Aug 2023
Last updated: 25 Nov 2022



History and exam

Key diagnostic factors

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

Other diagnostic factors

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

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
More risk factors

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
More 1st investigations to order

Investigations to consider

  • kidney biopsy
  • plain abdominal radiograph
  • abdominal CT
  • abdominal MRI
More investigations to consider

Treatment algorithm


GFR category G1 to G2 without uremia

GFR category G3 to G4 without uremia

GFR category G5 or with uremia



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



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



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 reviewers

Robert Toto, MD


Internal Medicine - Nephrology

Southwestern Medical School

The University of Texas Southwestern Medical Center at Dallas




RT declares that he has no competing interests.

Guy H. Neild, MD, FRCP, FRCPath

Professor of Nephrology

UCL Division of Medicine

University College London




GHN declares that he has no competing interests.

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