Chronic Kidney Disease (CKD)

Etiology

  • 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

Risk Factors

  • Hypertension, diabetes, atherosclerosis, older age

Symptoms

  • SOB, CP, HA
  • 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)

Physical Exam Findings

  • Often chronic HTN
  • Volume overload: pulmonary edema, peripheral edema
  • Often peripheral neuropathy, peripheral arterial disease, retinopathy (assoc w/atherosclerosis, DM),

Tests

Links