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For further information, see CMDT Part 24-11: Chronic Kidney Disease
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Essentials of Diagnosis
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Decline in glomerular filtration rate (GFR) over months to years
Persistent proteinuria or abnormal renal morphology may be present
Hypertension is commonly present
Symptoms and signs of uremia when nearing end-stage disease
Bilateral small or echogenic kidneys on ultrasound in advanced disease
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General Considerations
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Affects at least 10% of Americans
Chronic kidney disease (CKD) staging system (Table 24–5)
Over 70% of cases of late-stage CKD (stage 5 CKD and end-stage kidney disease [ESKD]) 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 24–6)
Genetic polymorphisms of the APOL-1 gene are associated with an increased risk of developing CKD in persons of Sub-Saharan African ancestry
Progressive decline in kidney function
Potentially reversible or exacerbating causes of kidney disease that should be addressed include
Urinary obstruction
Hypovolemia, hypotension
Nephrotoxins (such as nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, or proton pump inhibitors)
Severe or emergent hypertension
Heart failure exacerbation
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