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Doença renal crônica

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Last reviewed: 13 Jan 2026
Last updated: 14 Nov 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • fadiga
  • edema
  • náuseas com/sem vômitos
  • prurido
  • alterações na pele e na unha
  • pernas inquietas
  • anorexia
  • doença glomerular relacionada à infecção
Full details

Other diagnostic factors

  • artralgia
  • próstata aumentada
  • urina espumosa
  • urina cor de cola ou de chá
  • erupções cutâneas
  • dispneia
  • ortopneia
  • convulsões
  • retinopatia
Full details

Risk factors

  • diabetes mellitus
  • hipertensão
  • idade >50 anos
  • doença renal infantil
  • tabagismo
  • obesidade
  • etnia negra não hispânica
  • história familiar de DRC
  • doenças autoimunes
  • sexo masculino
  • uso prolongado de anti-inflamatórios não esteroidais (AINEs)
  • níveis altos de ácido úrico
Full details

Diagnostic tests

1st tests to order

  • perfil bioquímico renal
  • estimativa de TFG usando creatinina sérica
  • estimativa de TFG usando cistatina C com ou sem creatinina sérica
  • urinálise
  • albumina urinária
  • ultrassonografia renal
Full details

Tests to consider

  • biópsia renal
  • radiografia abdominal simples
  • rastreamento de diabetes
  • avaliação do distúrbio ósseo e mineral
  • avaliação de anemia
Full details

Emerging tests

  • teste genético

Treatment algorithm

ACUTE

TFG categoria G1 a G2

TFG categoria G3 a G4

TFG categoria G5

Contributors

Authors

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

AR

Disclosures

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

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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 to users with access to all of BMJ Best Practice.

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