Chronic kidney disease
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
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
Disclosures
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
Disclosures
MWK declares that she has no competing interests.
Acknowledgements
Dr Manisha Singh and Dr Michelle Krause would like to gratefully acknowledge Professor Sudhir V. Shah, a previous contributor to this topic.
Disclosures
SVS declares that he has no competing interests.
Peer reviewers
Robert Toto, MD
Professor
Internal Medicine - Nephrology
Southwestern Medical School
The University of Texas Southwestern Medical Center at Dallas
Dallas
TX
Disclosures
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
Disclosures
GHN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].Full text
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.Full text Abstract
Kalantar-Zadeh K, Jafar TH, Nitsch D, et al. Chronic kidney disease. Lancet. 2021 Aug 28;398(10302):786-802. Abstract
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.Full text
Reference articles
A full list of sources referenced in this topic is available here.
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