Most common are longstanding hypertension (hypertensive nephrosclerosis), diabetes (glomerulosclerosis), or both
Renal vascular disease: atherosclerosis; much less commonly arterial or venous infarct
Glomerulonephritis: lupus, gpa, mpa, rpgn, cryoglobulinemia, IgA nephropathy, antiglomerular basement membrane disease, membranoproliferative, RPGN, post-strep, PAN
Associated w/Nephrotic syndrome: FSGS, membranous nephropathy, membranoproliferative, minimal change, myeloma, amyloid
Tubulointerstitial disease: injury from lithium, other meds, damage from pyelonephritis, chronic reflux
Irreversible glomerular loss from Acute Kidney Injury: e.g. severe ATN from pre-renal azotemia and/or contrast; long standing obstructive uropathy that wasn't corrected; other toxic exposure
Other: Polycystic kidney disease, Allports disease, Renal Tubular Acidosis, other unusual primary kidney disorders
Hypertension, diabetes, atherosclerosis, older age
Fatigue, weakness
Weight loss (poor PO intake, poor nutritional state), or weight gain (volume overload)
Nausea, vomiting, confusion
Symptoms vary with severity of disease, presence of co-morbid conditions (in particular, cardiovascular disease and DM)
Often chronic HTN
Volume overload: pulmonary edema, peripheral edema
Often peripheral neuropathy, peripheral arterial disease, retinopathy (assoc w/atherosclerosis, DM),
Chronic kidney disease: abnormal kidney function or structure x 3m; GFR > 90 (nl or high); Stage 2, GFR 60-90ml/min (mild decrease); 3a 45-59 (mild-mod); 3b 30-44 (mod-severe); 4 15-29 (severe); 5 < 15 (failure)
Anemia of chronic disease (low epo)
Hypocalcemia, hyperphosphatemia (from low 1,25 vitamin D, elevated PTH secondary to phosphate retention)
Metabolic acidosis, hyperkalemia
UA with significant proteinuria if related to glomerular dz (e.g. DM)