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For further information, see CMDT Part 22-12: 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 ultrasound in advanced disease

General Considerations

  • Affects at least 10% of Americans

  • CKD staging system (Table 22–4)

  • Over 70% of cases of late-stage chronic kidney disease (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 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 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 NSAIDs, aminoglycosides, or proton pump inhibitors)

    • Severe or emergent hypertension

    • Heart failure exacerbation

Table 22–4.Stages of CKD: a clinical action plan.1,2
Table 22–5.Causes of CKD.

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