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For further information, see CMDT Part 22-10: Chronic Kidney Disease

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 22–5.Major causes of chronic kidney disease.

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

    • Anorexia

    • Nausea

    • Vomiting

    • Metallic taste in the mouth

  • 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

eTable 22–2.Symptoms and signs of uremia.

Differential Diagnosis

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