Chronic kidney disease is kidney damage or reduced kidney function that lasts at least 3 months, staged by eGFR and urine albumin. Diabetes and high blood pressure are the main causes, and the goals are to slow progression, protect the heart and plan ahead for dialysis or transplant.
Key symptoms
- No symptoms in early stages
- Fatigue, poor appetite and nausea in advanced disease
- Swelling of the legs and around the eyes
- Itching, muscle cramps and trouble sleeping
- Foamy urine or urinating at night
What you find on exam
- Blood pressure, often high
- Edema and weight change
- Pale skin from anemia
- Signs of heart failure or diabetic complications
Tests
- Creatinine with eGFR and urine albumin-to-creatinine ratio, repeated over 3 months
- Electrolytes, bicarbonate, calcium, phosphate and PTH
- Blood count for anemia; HbA1c and lipids
- Renal ultrasound for kidney size and structure
Treatment basics
- Blood pressure control with an ACE inhibitor or ARB, especially with albuminuria
- An SGLT2 inhibitor such as empagliflozin to slow progression
- Glucose control, a statin and smoking cessation
- Avoid NSAIDs and adjust drug doses to eGFR
- Treat anemia, bone mineral problems and acidosis; refer early for dialysis or transplant planning
Red flags
- Potassium above 6.0 mmol/L
- Fluid overload with shortness of breath
- Uremic confusion, pericardial rub or a rapid fall in eGFR
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.