Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Decline in the glomerular filtration rate (GFR) over months to years Persistent proteinuria or abnormal renal morphology may be present Hypertension in most cases Symptoms and signs of uremia when nearing end-stage disease Bilateral small or echogenic kidneys on ultrasonogram in advanced disease +++ General Considerations ++ Affects 10% of Americans Over 70% of cases of late-stage chronic kidney disease (CKD) (stage 5 CKD and end-stage renal disease [ESRD]) in the United States are due to diabetes mellitus or hypertension/vascular disease Glomerulonephritis, cystic diseases, chronic tubulointerstitial diseases, and other urologic diseases account for the remainder (Table 22–5) Genetic polymorphisms of the APOL-1 gene have been shown to be associated with an increased risk of the development of CKD in persons of African descent Progressive decline in kidney function ++Table Graphic Jump LocationTable 22–5.Major causes of chronic kidney disease.View Table|Favorite Table|Download (.pdf) Table 22–5. Major causes of chronic kidney disease. Glomerular Diseases Primary glomerular diseases Focal segmental glomerulosclerosis Membranoproliferative glomerulonephritis IgA nephropathy Membranous nephropathy Alport syndrome (hereditary nephritis) Secondary glomerular diseases Diabetic nephropathy Renal amyloidosis Postinfectious glomerulonephritis HIV-associated nephropathy Collagen-vascular diseases (eg, SLE) HCV-associated membranoproliferative glomerulonephritis Tubulointerstitial Nephritis Drug hypersensitivity Heavy metals Analgesic nephropathy Reflux/chronic pyelonephritis Sickle cell nephropathy Idiopathic Cystic Diseases Polycystic kidney disease Medullary cystic disease Obstructive Nephropathies Prostatic disease Nephrolithiasis Retroperitoneal fibrosis/tumor Congenital Vascular Diseases Hypertensive nephrosclerosis Renal artery stenosis HCV, hepatitis C virus; SLE, systemic lupus erythematosus. +++ Clinical Findings +++ Symptoms and Signs ++ Symptoms develop slowly with the progressive decline in GFR and are nonspecific Can be asymptomatic until kidney disease is far advanced (GFR < 5–10 mL/min/1.73 m2) General symptoms of uremia (eTable 22–2): fatigue and weakness Anorexia, nausea, vomiting, and metallic taste in the mouth are also common Hypertension is the most common sign Generalized pruritus (without rash) Irritability, memory impairment, insomnia, restless legs, paresthesias, and twitching Decreased libido, menstrual irregularities Pleuritic chest pain can occur with pericarditis (rare) Renal osteodystrophy (osteitis fibrosa cystica), osteomalacia, and adynamic bone disease ++Table Graphic Jump LocationeTable 22–2.Symptoms and signs of uremia.View Table|Favorite Table|Download (.pdf) eTable 22–2. Symptoms and signs of uremia. Organ System Symptoms Signs General Fatigue, weakness Sallow-appearing, chronically ill Skin Pruritus, easy bruisability Pallor, ecchymoses, excoriations, edema, xerosis ENT Metallic taste in mouth, epistaxis Urinous breath Eye Pale conjunctiva Pulmonary Shortness of breath Rales, pleural effusion Cardiovascular Dyspnea on exertion, retrosternal pain on inspiration (pericarditis) Hypertension, cardiomegaly, friction rub Gastrointestinal Anorexia, nausea, vomiting, hiccups Genitourinary Nocturia, erectile dysfunction Isosthenuria Neuromuscular Restless legs, numbness and cramps in legs Neurologic Generalized irritability and inability to concentrate, decreased libido Stupor, asterixis, myoclonus, peripheral neuropathy +++ Differential Diagnosis ++ See Table ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options