II. Definitions

  1. Chronic Kidney Disease
    1. Abnormal Kidney structure or function lasting more than 3 months, with associated health implications
  2. End Stage Renal Disease
    1. Kidney Function not adequate for longterm survival without Dialysis or renal transplant
    2. Stage 5 Chronic Kidney Disease (GFR <15 ml/min/1.73m2)

III. Epidemiology

  1. Chronic Kidney Disease (2016)
    1. Prevalence in U.S.: 47 million (14-15% of the adult U.S. population)
    2. Accounts for 20% of all medicare costs ($52 Billion/year in 2014)
  2. End Stage Renal Diseases
    1. Prevalence 2002: 435,000 in U.S.
    2. Prevalence 2016: 660,000 in U.S.
    3. Prevalence 2018: 750,000 in U.S.
    4. Accounts for 10% of all medicare fee-for-service costs

IV. Causes: Percentage is that of conditions responsible for ESRD

  1. Diabetes Mellitus (37%)
    1. See Diabetic Nephropathy
    2. Glycemic control is critical to slow progression
    3. Type I Diabetes Mellitus (represents 5% of ESRD patients)
      1. Progresses to ESRD in 40% of patients
    4. Type II Diabetes Mellitus (represents 32% of ESRD patients)
      1. Progresses to ESRD in 20% of patients
      2. Type II Diabetes is 10 times as common as Type
  2. Hypertension or Hypertensive Kidney Disease (30% overall, 40% in black patients)
  3. Human Immunodeficiency Virus Infection (HIV Infection)
  4. Glomerulonephritis and other glomerular diseases (21%)
    1. Includes Vasculitis (e.g. Systemic Lupus Erythematosus)
  5. Hereditary conditions
    1. Polycystic Kidney Disease (7%)
    2. Alport Syndrome
    3. Medullary Cystic disease
  6. Tubulointerstitial disease (4%)
    1. Infection with scarring
      1. Chronic Urinary Tract Infections (Pyelonephritis)
      2. Reflux nephropathy in children
    2. Urologic obstruction
      1. Nephrolithiasis (obstruction)
      2. Benign Prostatic Hyperplasia (BPH)
    3. Medication-induced Nephrotoxicity (Nephrotoxins)
      1. See Intravenous Contrast Related Acute Renal Failure
      2. See Risk Score for Prediction of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention

V. Risk Factors

  1. Diabetes Mellitus (leading cause)
  2. Autoimmune Conditions
  3. Chemical exposures (Lead, Cadmium, Arsenic, Mercury, Uranium)
  4. Nephrotoxin exposure (e.g. Intravenous Contrast Related Acute Renal Failure)
  5. Family History of Chronic Kidney Disease
  6. Hypertension
  7. Low birth weight
  8. Lower Urinary Tract Obstruction
  9. Cancer
  10. Nephrolithiasis
  11. Advanced age
  12. Acute Kidney Injury in past
  13. Decreased Renal Mass
  14. Serious systemic infection (e.g. Sepsis)
  15. Recurrent Urinary Tract Infections
  16. Minority status (blacks, native american, asian, pacific islander)

VI. History

  1. Recent infections
    1. Poststreptococcal Glomerulonephritis
  2. Sexually Transmitted Infection (STI, STD) risk factors including IV Drug Abuse
    1. HIV Infection
    2. Hepatitis B Infection
    3. Hepatitis C Infection
  3. Arthritis or dermatitis
    1. Systemic Lupus Erythematosus
    2. Cryoglobulinemia
  4. Urinary symptoms
    1. Urinary Tract Infection
    2. Nephrolithiasis
    3. Urinary Outflow Obstruction
  5. PMH
    1. Diabetes Mellitus
      1. Present for 5-10 years: Microalbuminuria, Pre-Hypertension
      2. Present for 10-15 years: Albuminuria, Retinopathy, Hypertension
    2. Hypertension
      1. Severe Hypertension
      2. End-organ effects
  6. Family History
    1. Autosomal Dominant Polycystic Kidney Disease
      1. Affects men and women in every generation
      2. May also occur less frequently if Autosomal Recessive
    2. Alport Syndrome (X-linked recessive)
      1. Affects men in every generation

VII. Exam

VIII. Symptoms: Stage 4-5

  1. Fatigue (75% of patients)
  2. Pruritus (75% of patients)
  3. Weakness
  4. Headaches
  5. Anorexia
  6. Nausea
  7. Vomiting
  8. Polyuria
  9. Nocturia
  10. Pain
    1. Musculoskeletal pain
    2. Dialysis associated pain
    3. Peripheral Neuropathy
    4. Peripheral Vascular Disease related pain

X. Criteria: Chronic Kidney Disease (at least one of the following criteria)

  1. GFR < 60 ml/min/1.73 m2 (based on two GFR calculations 3 months or more apart)
    1. Men: Serum Creatinine >1.5 mg/dl
    2. Women: Serum Creatinine >1.3 mg/dl
  2. Significant Proteinuria or albuminuria for >3 months (positive on 2 of 3 samples in 3-6 months)
    1. Urine Albumin to Creatinine Ratio >30 mg/g (Microalbuminuria, moderate) or >300 mg/g (severe)
      1. Urine Protein to Creatinine Ratio is less sensitive (but useful in albumin ratio >500 mg/g)
  3. Structural Kidney Disease or Kidney damage for >3 months
    1. Identify with renal Ultrasound
  4. Other criteria
    1. All renal transplant patients have Chronic Kidney Disease regardless of GFR or Proteinuria

XI. Stages: NKF Classification System

  1. Stage 1: GFR >90 ml/min despite Kidney damage
    1. Microalbuminuria present
  2. Stage 2: Mild reduction (GFR 60-89 min/min)
    1. GFR of 60 may represent 50% loss in function
    2. Parathyroid Hormone starts to increase
  3. Stage 3: Moderate reduction (GFR 30-59 ml/min, 3a: 45-59, 3b: 30-44)
    1. Calcium absorption decreases
    2. Malnutrition onset
    3. Anemia secondary to Erythropoietin deficiency
    4. Left Ventricular Hypertrophy
  4. Stage 4: Severe reduction (GFR 15-29 ml/min)
    1. Serum Triglycerides increase
    2. Hyperphosphatemia
    3. Metabolic Acidosis
    4. Hyperkalemia
  5. Stage 5: Kidney Failure (GFR <15 ml/min)
    1. Azotemia
  6. References
    1. (2002) Am J Kidney Dis 39:S1 [PubMed]
    2. Snively (2004) Am Fam Physician 70:1921-30 [PubMed]

XII. Labs: Screening for Chronic Kidney Disease

  1. Indications
    1. Diabetes Mellitus
    2. Hypertension
    3. Age over 55-60 years old
    4. Consider in Family History of Chronic Kidney Disease (see causes listed above)
  2. Tests
    1. Serum Creatinine (with Estimated Glomerular Filtration Rate)
    2. Urine Albumin to Creatinine Ratio
    3. Urinalysis with microscopy
  3. Assess Glomerular Filtration Rate (GFR)
    1. Estimations generally as accurate as 24 hour urine
      1. See Creatinine Clearance for exceptions
      2. GFR may also be estimated from Serum Cystatin C instead of Serum Creatinine
        1. Consider if abnormal GFR based on Creatinine Clearance suspected to be False Positive
    2. Formulas
      1. Chronic Kidney Disease Epidemiology Collaboration Equation or CKD-EPI (preferred standard)
        1. https://www.kidney.org/professionals/kdoqi/gfr_calculator
      2. Cockcroft-Gault equation
        1. Used only to calculate medication Renal Dosing
      3. Modification of Diet in Renal Disease (MDRD)
        1. CKD-EPI is preferred
  4. Assess for Proteinuria
    1. Previously Urinalysis dipstick was used to triage testing for spot Urine Protein or albumin
    2. As of 2012, Urinalysis is no longer recommended for Urine Protein screening
      1. Urine Albumin to Creatinine Ratio is recommended instead as a first-line study
  5. Assess other urinary sediment on Urinalysis
    1. Microscopic Hematuria
    2. Urine White Blood Cells (pyuria)
    3. Cellular Casts
    4. Lipiduria (seen in nephrotic sediment)
      1. Indicated by Fatty Casts, oval fat bodies, or free fat in urine sediment
      2. Increases significance of Proteinuria
    5. Eosinophiluria
      1. Tubulointerstitial disease
      2. Atheroembolic dsisease

XIII. Labs: Urine sediment found in causes of Chronic Kidney Disease

  1. Polycystic Kidney Disease
    1. Protein to Creatinine ratio 200-1000 mg/g
    2. Red Blood Cells present
  2. Diabetic Nephropathy
    1. Albumin to Creatinine ratio 30-300 early (and exceeds 300 in later disease)
  3. Hereditary Nephritis
    1. Protein to Creatinine ratio <1000 mg/g
    2. Red Blood Cells, tubular cells and Granular Casts present
  4. Hypertensive Nephropathy
    1. Protein to Creatinine ratio 200-1000 mg/g
  5. Noninflammatory Glomerular Disease
    1. Protein to Creatinine ratio >1000 mg/g
  6. Proliferative Glomerulonephritis
    1. Protein to Creatinine ratio >500 mg/g
    2. Red Blood Cells, Red Blood Cell Casts, White Blood Cells, White Blood Cell Casts present
  7. Tubulointerstitial Nephritis
    1. Protein to Creatinine ratio 200-1000 mg/g
    2. Red Blood Cells, White Blood Cells, White Blood Cell Casts present
  8. IgA Nephropathy or Rapidly Progressive Glomerulonephritis (RPGN)
    1. Dysmorphic urinary Red Blood Cells or
    2. Red Blood Cell Casts

XIV. Labs: Findings in Chronic Kidney Disease Stages 3-4

  1. Anemia (Normochromic, Normocytic)
    1. Hematocrit decreases
      1. Serum Creatinine > 2-3
      2. Glomerular Filtration Rate <20-30
    2. Results from decreased Erythropoietin synthesis
  2. Azotemia
  3. Decreased Serum Protein
  4. Serum chemistry abnormalities
    1. Hyperkalemia or Hypokalemia
    2. Metabolic Acidosis
    3. Hypocalcemia
    4. Hyperphosphatemia

XV. Labs: Initial presentation

  1. Screening labs (see above)
    1. Serum Creatinine (with Estimated Glomerular Filtration Rate)
    2. Urine Albumin to Creatinine Ratio
    3. Urinalysis with microscopy
      1. Evaluates for intrinsic renal disease causes
  2. Basic labs
    1. Basic metabolic panel (includes serum Electrolytes)
    2. Fasting lipid profile
    3. Hemoglobin A1C
    4. Serum Calcium
    5. Serum Phosphorus
    6. Complete Blood Count (CBC)
    7. Vitamin D
  3. Additional labs as indicated
    1. Antinuclear Antibody (ANA)
      1. Lupus Nephritis
    2. Urine and Serum Protein Electrophoresis
      1. Multiple Myeloma
    3. Hepatitis B Serology (HBsAg)
      1. Membranous Nephropathy
      2. Membranoproliferative nephritis)
    4. Hepatitis C Serology (xHBC Antibody)
      1. Membranous Nephropathy
      2. Membranoproliferative Glomerulonephritis
      3. Mixed Cryoglobulinemia
    5. HIV Test
      1. Focal and segmental glomerulosclerosis
    6. Antistreptolysin O Antibody (ASO Titer)
      1. Post-Streptococcal Glomerulonephritis
    7. Antineutrophil Cytoplasmic Antibody (ANCA)
      1. Granulomatosis with Polyangiitis (previously known as Wegener's Granulomatosis)
      2. Microscopic Polyangiitis
      3. Pauci-immune Rapidly Progressive Glomerulonephritis
    8. Anti-Glomerular Basement Membrane Antibody (Anti-GBM Antibody)
      1. Goodpasture Syndrome (xGBM Antibody associated with rapid progression)
    9. Consider serum complement studies (C3, C4, CH50)
      1. Post-Streptococcal Glomerulonephritis
      2. Membranoproliferative Glomerulonephritis
      3. Lupus Nephritis
      4. Cryoglobulinemia
    10. Cryoglubulin Test
      1. Cryoglobulinemia
    11. Eosinophiluria
      1. Tubulointerstitial Disease
  4. Other diagnostics
    1. Consider baseline Electrocardiogram (coronary disease is a common complication of CKD)

XVI. Labs: Monitoring

  1. General labs
    1. Basic metabolic panel (Serum Creatinine and serum Electrolytes) every 3-12 months or more
    2. Urine Albumin to Creatinine Ratio every 12 months
  2. Anemia monitoring (at least annually, or more often as indicated)
    1. Complete Blood Count with differential
    2. Reticulocyte Count
    3. Serum Iron
    4. Serum Ferritin
    5. Serum Transferrin
    6. Vitamin B12
    7. Serum Folate
  3. Malnutrition monitoring (every 6-12 months, up to every 1 to 3 months in stage 4-5 CKD)
    1. Serum Albumin
    2. Body weight
    3. Dietary history
  4. Bone disorders
    1. See Chronic Kidney Disease related Bone Disease (Renal Osteodystrophy)
    2. Alkaline Phosphatase
      1. Obtain at baseline
      2. Obtain every 12 months in Stage 4 and 5 CKD
    3. Serum Calcium and Serum Phosphorus
      1. Obtain every 3 to 6 months (as often as every 1 to 3 months in Stage 5 CKD)
    4. 25-hydroxyvitamin D and Intact Parathyroid Hormone (iPTH)
      1. Obtain at baseline
      2. Obtain every 3 to 6 months in Stage 4 (or every 1 to 3 months in Stage 5)

XVII. Imaging: Renal Ultrasound (indicated in most patients on initial presentation)

  1. Doppler Ultrasound
    1. Renal veins: Venous thrombosis
    2. Renal arteries: Lower efficacy in diagnosing Renal Artery Stenosis
  2. General findings
    1. Nephrocalcinosis
    2. Hydronephrosis
    3. Renal Mass or complex cysts (concerning for malignancy risk)
    4. Renal stones
  3. Increased echogenicity
    1. Renal disease
  4. Enlarged Kidneys
    1. Renal tumors
    2. Infiltrating disease
    3. Nephrotic Syndrome related conditions
  5. Asymmetric Kidney size or scarred Kidneys
    1. Vascular disease
    2. Urologic disease
    3. Tubulointerstitial disease
  6. Small, hyperechoic Kidneys
    1. Chronic Kidney Disease

XVIII. Imaging: Other advanced imaging

  1. Consider CT or MRI of Kidneys and Liver
  2. Consider Voiding Cystourethrogram

XIX. Diagnosis: Renal Biopsy

  1. Indications
    1. Hematuria and low Creatinine Clearance or Proteinuria
    2. Nephrotic range Proteinuria
    3. Chronic Renal Failure with normal or large Kidneys
    4. Acute Renal Failure of unknown cause
  2. Contraindications
    1. Renal length <9 cm
    2. Severe Hypertension
    3. Multiple large Renal Cysts
    4. Uncorrected bleeding tendency
    5. Hydronephrosis
    6. Acute infection

XX. Management: Secondary Prevention

  1. Protocols
    1. See Prevention of Kidney Disease Progression
    2. See Drug Dosing in Chronic Kidney Disease
    3. See Renal Osteodystrophy
    4. See Nephrotoxic Drugs
    5. See Intravenous Contrast Related Acute Renal Failure
    6. See Gadolinium-Associated Nephrogenic Systemic Fibrosis (Nephrogenic Fibrosing Dermopathy)
  2. Proteinuria (Microalbuminuria or Macroalbuminuria)
    1. Start ACE Inhibitor or Angiotensin Receptor Blocker
  3. Coronary Artery Disease Prevention
    1. Aspirin 81 mg orally daily
    2. Statin for most patients
    3. Control Hypertension
  4. Hypertension (common in ESRD)
    1. Hypertension correlates with volume status
      1. Modify hemodilaysis to maintain normovolemia
    2. Sodium Restriction 2 g/day
    3. Antihypertensives
    4. Ambulatory or home Blood Pressure measurements are more preferred for BP monitoring over Dialysis center BPs
  5. Diabetes Mellitus
    1. Maintain careful Blood Glucose Monitoring in ESRD (higher risk for Hypoglycemia)
    2. Hemodialysis typically helps improve Hyperglycemia management
    3. Hemoglobin A1C may be inaccurate in ESRD (esp. on Hemodialysis)
      1. Glucose monitoring logs are preferred
    4. Insulin is preferred in ESRD or GFR <30 ml/min/1.73m2
      1. Many other diabetic medications (e.g. Metformin) are contraindicated in low GFR
      2. Alternatives include Glipizide (but risk of Hypoglycemia) and Repaglinide
  6. Medication limitations for GFR <30 ml/min
    1. Avoid Metformin and Flozins (SGLT2 Inhibitors) in Type II Diabetes
    2. Avoid Bisphosphonates
    3. Avoid Direct Oral Anticoagulants
    4. Avoid NSAIDs
    5. For Bowel Preparation, use Polyethylene glycol (PEG) instead of Magnesium or Phosphorus preparations
  7. Vaccination
    1. Influenza Vaccine
    2. Tetanus Vaccine
    3. Hepatitis B Vaccine
    4. Pneumococcal Vaccine (Pneumovax-23 and Prevnar 13)
    5. Covid-19 Vaccine
    6. Recombinant Shingles Vaccine (Shingrix) if indicated
  8. Cancer Screening is not recommended in End Stage Renal Disease (ESRD)
    1. Life Expectancy in ESRD is not sufficient to warrant longterm cancer screening

XXI. Management: Nephrology Referral

  1. Indications
    1. Chronic Kidney Disease Stage 4 (GFR <30 ml/minute)
      1. Consider initial evaluation when GFR <60 ml/minute
    2. Chronic Kidney Disease with rapid progression
      1. Unexplained decrease in GFR >30% over 4 months
      2. Annual GFR decline >5 ml/min/1.73m2
      3. Kidney Failure Risk Calculator estimates one year ESRD risk >10-20%
        1. https://www.mdcalc.com/kidney-failure-risk-calculator
    3. Acute failure complicating Chronic Kidney Disease
    4. Unclear etiology for Renal Failure
    5. Hereditary Kidney Disease
    6. Renal biopsy
    7. Nephrotic sediment (e.g. lipiduria)
    8. RBC Casts (indicates an urgent referral)
    9. Extensive or recurrent Nephrolithiasis
    10. Urine Eosinophils
    11. Refractory Hypertension despite at least 3 antihypertensives
    12. Significant Proteinuria
      1. 24 Hour Urine Protein > 1000 mg
      2. Protein to Creatinine ratio >500-1000 mg/g
      3. Albumin to Creatinine ratio >300 mg/g despite 6 months on ACE Inhibitor (or ARB)
    13. Acute Tubular Necrosis
    14. Significant comorbidity (e.g. cardiovascular disease)
    15. Complications of Chronic Kidney Disease
      1. Anemia of Chronic Kidney Disease
      2. Bone and mineral disorders of Chronic Kidney Disease
      3. Hyperkalemia (Potassium >5.5 meq despite modification of therapy)
  2. Goals of Nephrology Care
    1. Initiate disease specific management including complications and related comorbidity
    2. Intervene to slow Chronic Kidney Disease progression
    3. Planning for Hemodialysis, conservative management or renal Transplantation
    4. Coordinate with multidisciplinary care

XXII. Management: End Stage Renal Disease

  1. Hemodialysis or Peritoneal Dialysis
    1. See Hemodialysis
    2. See Peritoneal Dialysis
    3. Absolute Dialysis Indications
      1. Uremic Symptoms
      2. Uremic Pericarditis
    4. Relative Dialysis Indications
      1. Hypervolemia
      2. Hyperkalemia or other Electrolyte abnormalities
      3. Severe Metabolic Acidosis
      4. Creatinine Clearance <10 ml/min (<15 ml/min in Diabetes Mellitus)
  2. Renal Transplantation
    1. Improves overall survival and quality of life in comparison to Dialysis and conservative management
    2. Refer to renal transplant when GFR <30 ml/min/1.73m2 to allow for adequate planning, preparation, wait list time
    3. As of 2020, the median time of renal transplant wait list is 4 years
    4. Less rejection if transplant before Dialysis started
      1. Mange (2001) N Engl J Med 344:726-31 [PubMed]
  3. Conservative management options (palliative approach)
    1. Optimizes quality of life over prolongation of life
      1. Survival benefit of Hemodialysis is reduced in elderly and comorbidity
      2. Uremia symptoms may not significantly improve with Hemodialysis
      3. Hemodialysis is associated with increased medical interventions
    2. More than half of chronic Hemodialysis patients regret their decision to undergo Hemodialysis
      1. Davison (2010) Clin J Am Soc Nephrol 5(2): 195-204 [PubMed]
    3. Non-Dialysis with Hospice care
    4. Delayed Dialysis until Creatinine Clearance <5 ml/min (similar morbidity and mortality)
      1. Cooper (2010) N Engl J Med 363(7):609-19 [PubMed]

XXIII. Management: Anemia

  1. Erythropoietin (EPO)
    1. Efficacy
      1. Initial studies showed benefit for Erythropoietin
        1. Renicki (1995) Am J Kidney Dis 25:548-54 [PubMed]
      2. Recent studies show no benefit and higher risk of Cerebrovascular Accident
        1. Outcomes are the same with and without normalized Hemoglobin via erythropoetin
        2. Morbidity and patient sense of well-being is not improved on erythropoetin
        3. Pfeffer (2009) N Engl J Med 361 [PubMed]
    2. Indications for Erythropoeitin
      1. Hemoglobin <9 mg/dl
    3. Adverse effects
      1. Increased risk of Cerebrovascular Accident
  2. Iron Supplementation
    1. Often indicated in Hemodialysis patients
    2. Parenteral replacement is often needed (decreased oral absorption)
      1. Non-Dextran IV Iron
        1. Indicated in significant Iron Deficiency refractory to oral replacement
        2. Options: Ferumoxytol (Feraheme), iron sucrose (venafer) or Sodium Ferric Gluconate (Ferrlecit)
      2. Ferric pyrophosphate (Triferic)
        1. Available in 2015 (U.S.)
        2. Indicated for maintenance iron infusion
        3. May be delivered inline with Hemodialysis
    3. References
      1. (2015) Presc Lett 22(4)

XXIV. Management: Anorexia and Protein Energy Wasting in ESRD

  1. Minimize Uremia with adequate Dialysis frequency
  2. Consider Major Depression, Gastroparesis, and Xerostomia
  3. Protein Energy Wasting Findings
    1. BMI < 23 kg/m2
    2. Unintentional Weight Loss (>5% over 3 months or >10% over 6 months)
    3. Serum Albumin <3.8 g/dl
  4. General Measures
    1. Dietician Consultation
    2. High Protein diet 1.0 to 1.2 g Protein/kg/day in ESRD
      1. Contrast with the limited Protein diet in Chronic Kidney Disease to prevent progression
      2. Consider dietary Protein Supplementation
  5. Medications
    1. Dronabinol 2.5 mg orally before meals
    2. Megestro 400 mg orally daily
    3. Prednisone 10 mg orally daily

XXV. Management: Symptomatic Management in ESRD

  1. Agitation
    1. Haloperidol 1 mg PO, IV or IM every 12 hours
  2. Dyspnea
    1. Regular Physical Activity to prevent deconditioning
    2. Fentanyl (Duragesic) 12.5 mg IV or SQ every two hours as needed for end-of-life
  3. Fatigue
    1. Treat Anemia if present
    2. Consider Depression Management with Fluoxetine 20 mg daily or Sertraline 50 mg daily
  4. Nausea and Vomiting
    1. Minimize Uremia with adequate Dialysis frequency
    2. Ondansetron 4 mg orally every 8 hours
    3. Metoclopramide (Reglan) 5 mg twice daily
    4. Haloperidol (Haloperidol) 0.5 mg orally every 8 hours
  5. Pruritus
    1. Minimize Uremia with adequate Dialysis frequency
    2. Phosphate Binders
    3. Standar Dry Skin therapy (e.g. barrier creams)
    4. Ondansetron 4 mg orally every 8 hours
    5. Hydroxyzine (Atarax or Vistaril), 25 mg orally every 6 hours
    6. Naltrexone (Revia) 50 mg orally daily
    7. Phototherapy (UV-B Light)
  6. Insomnia
    1. See Sleep Hygiene
    2. Treat Restless Leg Syndrome
    3. Treat Obstructive Sleep Apnea
    4. Zolpidem 5 mg orally at bedtime
    5. Temazepam (Restoril) 15 mg orally at bedtime

XXVI. Management: Advanced Directives in ESRD

  1. Cardiopulmonary Resuscitation (CPR)
    1. Survival in ESRD is only 8% at hospital discharge and 3% at six months
    2. Contrast with CPR in non-ESRD with survival of 12% at discharge and 9% at six months
    3. Discuss Do-Not-Reuscitate status at routine visits
  2. Hospice
    1. Criteria to qualify for Hospice services paid by medicare in End Stage Renal Disease
      1. ESRD on no-Dialysis management or
      2. ESRD on Dialysis and other Hospice qualifying condition (e.g. cancer)

XXVII. Complications

  1. Cardiovascular Disorders
    1. See Hypotension in the Dialysis Patient
    2. Coronary Artery Disease (21% of ESRD cases)
    3. Peripheral Vascular Disease
    4. Cardiac Arrhythmias
    5. Congestive Heart Failure
    6. Uremic Cardiomyopathy
    7. Erectile Dysfunction
    8. Uremic Pericarditis
    9. Severe Refractory Hypertension
    10. Pulmonary Edema
    11. High-output Heart Failure (secondary to Anemia or Arteriovenous Fistula)
    12. Calciphylaxis
      1. Life-threatening, small vessel Occlusion in skin and fatty tissue presenting with necrotic skin lesions
    13. Uremic Pericardial Effusion
      1. Consider in Chronic Renal Failure with Dyspnea
      2. Risk of Cardiac Tamponade (consider in any ill ESRD patient)
  2. Hematologic
    1. Pancytopenia
      1. Anemia (Normochromic, Normocytic)
      2. Thrombocytopenia
      3. Leukopenia
  3. Neurologic disorders
    1. Subdural Hematoma
      1. Consider in any altered LOC patient with ESRD
    2. Uremic encephalopathy (Memory Loss, slurred speech, asterixis)
    3. Dialysis Dementia
      1. Associated with >2 years on Dialysis
      2. Diagnosis of exclusion
    4. Peripheral Neuropathy (e.g. extremity Paresthesias)
    5. Restless Leg Syndrome
    6. Sleep Disorders
    7. Thiamine deficiency (and Wernicke's Encephalopathy)
      1. Hung (2001) Am J Kidney Dis 38(5):941-7 +PMID:11684545 [PubMed]
  4. Fluids, Electrolytes and Nutrition
    1. Metabolic Acidosis
      1. Associated with increased mortality and other adverse outcomes
      2. Improves with Dialysis
      3. Consider Bicarbonate Supplementation in persistently low serum bicarbonate
    2. Muscle wasting and Malnutrition
    3. Pseudogout
    4. Uremia (Nausea, Vomiting, Anorexia)
    5. Hyperphosphatemia (see Renal Osteodystrophy)
  5. Gastrointestinal disorders
    1. Chronic Constipation
    2. Gastritis
    3. Peptic ulcers
    4. Uremic Gastroparesis
  6. Skin disorders
    1. Pruritus
    2. Calciphylaxis
    3. Uremic frost
      1. Occurs in end-stage renal disease with high BUN (untreated or missed Hemodialysis)
      2. Crystallized urea from sweat forms and deposits on the skin
      3. Uremic frost resembles Seborrhea
  7. Miscellaneous disorders
    1. Chronic Kidney Disease related Bone Disease (Renal Osteodystrophy)
    2. Amenorrhea
    3. Uremic Platelet disorder

XXVIII. Course

  1. Progression of Chronic Kidney Disease (<55 mmHg) is predictable
    1. Glomerular Filtration Rate (GFR) decreases -4 ml/min per year if no intervention
    2. Intensive management may halt GFR decline
      1. See Prevention of Kidney Disease Progression
  2. Major causes of death in ESRD
    1. Myocardial Infarction
    2. Cerebrovascular Accident

XXIX. Prognosis

  1. Annual mortality of ESRD: 24%
  2. Five Year survivalof ESRD
    1. All ages: 38%
    2. Age over 65 years: 18%

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Related Studies

Ontology: Kidney Failure, Chronic (C0022661)

Definition (NCI) Impairment of the renal function due to chronic kidney damage.
Definition (CSP) irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance.
Definition (MSH) The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION.
Concepts Disease or Syndrome (T047)
MSH D007676
ICD9 585.6
ICD10 N18 , N18.9, N18.0, N18.90
SnomedCT 46177005, 155856009, 197654000, 197755007, 197655004, 90688005
LNC LP146090-8
English Kidney Failure, Chronic, Renal Failure, Chronic, KIDNEY FAILURE CHRONIC, End-Stage Kidney Disease, ESRD, End-Stage Renal Disease, Renal Disease, End-Stage, Renal Failure, End-Stage, Disease, End-Stage Kidney, Disease, End-Stage Renal, End-Stage Renal Failure, Kidney Disease, End-Stage, Renal Disease, End Stage, Renal Failure, End Stage, End Stage Kidney Disease, End Stage Renal Disease, RENAL FAILURE CHRONIC, CRF, Chronic renal failure, unspecified, ESCRF - End stge chr renl fail, End stage renal failure, End-stage renal disease, RENAL FAILURE CHRONIC <UREMIA>, End stage chronic renal failure, End stage chronc renal failure, END STAGE KIDNEY DIS, RENAL DIS END STAGE, END STAGE RENAL DIS, end stage renal failure, chronic renal failure, end stage renal disease, end stage renal disease (diagnosis), chronic renal failure (diagnosis), ESRD (end stage renal disease), Kidney failure chronic, Renal failure chronic, End stage renal disease (ESRD), RENAL FAILURE CHRONIC UREMIA, CRF - Chronic Renal Failure, Chronic renal disease, Chronic renal failure NOS, Kidney Failure, Chronic [Disease/Finding], Unspecified chronic renal failure, chronic kidney insufficiency, Failure;renal;chronic, chronic renal insufficiency, end stage renal disease (ESRD), end-stage renal disease, end-stage renal failure, esrd, chronic kidney failure, end-stage kidney disease, chronic renal failure (CRF), end stage kidney disease, Chronic renal insufficiency, Renal failure, chronic, End-stage renal failure, Renal failure - chronic, Renal failure (chronic), End stage renal failure (disorder), Failure, renal -chronic, Chronic kidney failure, Chronic renal failure, Chronic renal failure syndrome, End-stage kidney disease, End stage renal disease, End stage kidney disease, CRF - Chronic renal failure, ESCRF - End stage chronic renal failure, ESRD - End stage renal disease, ESRF - End stage renal failure, Chronic renal failure syndrome (disorder), End stage renal disease (disorder), disease (or disorder); kidney, end-stage, disease (or disorder); renal, end-stage, Chronic renal failure syndrome, NOS, Chronic Renal Failure, Chronic Renal Disease, Chronic Kidney Failure
French INSUFFISANCE RENALE CHRONIQUE, Défaillance rénale terminale, Insuffisance rénale chronique au stade ultime (IRSU), Insuffisance rénale chronique, Défaillance rénale chronique
Portuguese INSUFICIENCIA RENAL CRONICA, Insuficiência renal de fase terminal, Doença renal de fase terminal, Falência Crônica do Rim, Insuficiência renal crónica, ESRD, Doença Renal Terminal, Insuficiência Renal Terminal, Nefropatia Terminal, Falência Crônica Renal, Falência Renal Crônica
Spanish INSUFICIENCIA RENAL CRONICA, Fallo renal terminal, Fallo renal crónico, Enfermedad renal terminal (ERT), RINON, INSUFICIENCIA CRONICA, Fallo Crónico del Riñón, Fracaso Renal Crónico, enfermedad renal terminal, insuficiencia renal en estadio terminal (trastorno), insuficiencia renal en estadio terminal, Insuficiencia renal crónica, NFF, Enfermedad Renal Terminal, Insuficiencia Renal Terminal, Nefropatía Terminal, Fallo Crónico Renal, Fallo Renal Crónico
Dutch nierfalen chronisch, terminaal nierfalen, terminale nierziekte, aandoening; nier, terminaal, aandoening; renaal, terminaal, Chronische nierinsufficiëntie, niet gespecificeerd, Terminale nierziekte, chronisch nierfalen, Nierfalen, chronisch, Nierfalen, eindstadium-, Nierziekte, eindstadium-, Chronische nierinsufficiëntie, Insufficiëntie, chronische nier-, Nierinsufficiëntie, chronische, Renale insufficiëntie, chronische
German chronisches Nierenversagen, terminales Nierenversagen, terminale Nierenerkrankung (ESRD), Chronische Niereninsuffizienz, nicht naeher bezeichnet, Chronische Niereninsuffizienz, NIERENVERSAGEN CHRONISCH, RENALES VERSAGEN CHRONIC, Terminale Niereninsuffizienz, Nierenversagen chronisch, ESRD, Nierenkrankheit, Endstadium, Nierenversagen, chronisches, Renales Versagen, Endstadium, Renales Versagen, chronisches, Terminale Nierenerkrankung, Chronisches Nierenversagen
Italian Insufficienza renale in stadio terminale, Nefropatia in stadio terminale, ESRD, Malattia del rene allo stadio terminale, Insufficienza renale allo stadio terminale, Malattia renale allo stadio terminale, Insufficienza renale cronica
Japanese 末期腎不全, 末期腎疾患(ESRD), マンセイジンフゼン, マッキジンシッカンESRD, マッキジンフゼン, 腎不全-慢性, 腎機能不全-慢性, 慢性腎不全, 慢性腎機能不全, 腎不全末期, 腎臓疾患末期, 腎不全-末期, 腎臓疾患-末期
Swedish Njursvikt, kronisk
Czech chronická renální insuficience, Konečné stadium renálního onemocnění, Chronické selhání ledvin, Chronické renální selhání, chronické selhání ledvin, ledviny - selhání chronické, Chronic Kidney Disease, CKD
Finnish Krooninen munuaisten vajaatoiminta
Korean 상세불명의 만성 콩팥(신장)기능상실, 만성 콩팥(신장)기능상실, 말기 콩팥(신장)병
Polish Schyłkowa niewydolność nerek, Niewydolność nerek przewlekła krańcowa, Niewydolność nerek przewlekła całkowita, Przewlekła nieodwracalna niewydolność nerek, Niewydolność nerek schyłkowa
Hungarian Chronikus veseelégtelenség, chronikus veseelégtelenség, végstádiumú veseelégtelenség, végstádiumú vesebetegség (ESRD)
Norwegian Kronisk nyresvikt, ESRD

Ontology: Chronic Kidney Insufficiency (C0403447)

Definition (MSH) Conditions in which the KIDNEYS perform below the normal level for more than three months. Chronic kidney insufficiency is classified by five stages according to the decline in GLOMERULAR FILTRATION RATE and the degree of kidney damage (as measured by the level of PROTEINURIA). The most severe form is the end-stage renal disease (CHRONIC KIDNEY FAILURE). (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002)
Concepts Disease or Syndrome (T047)
MSH D051436
ICD10 N18.91
SnomedCT 236425005
Dutch chronische nierfunctie vermindering, chronische nierinsufficiëntie, insufficiëntie; nier, chronisch, terminale nierziekte, insufficiëntie; nier, chronisch, insufficiëntie; nier, terminaal, nier; insufficiëntie, chronisch
French Dégradation chronique de la fonction rénale, IRC (Insuffisance Rénale Chronique), Insuffisance rénale chronique
German chronische Niereninsuffizienz, chronisches Niereninsuffizienz, Chronische Niereninsuffizienz, Niereninsuffizienz, chronische, Renale Insuffizienz, chronische, Chronische renale Insuffizienz
Italian Insufficienza renale cronica, Danno renale cronico, Riduzione della funzionalità renale cronica, Disfunzione renale cronica, Malattia renale cronica
Portuguese Insuficiência renal crónica, Compromisso renal crónico, Insuficiência Renal Crônica, Doenças Crônicas Renais, Doenças Crônica do Rim, Doenças Crônicas do Rim, Insuficiências Renais Crônicas, Doença Renal Crônica, Doença do Rim Crônica, Insuficiência Crônica Renal, Insuficiências Crônicas do Rim, Insuficiências do Rim Crônicas, Insuficiências Crônicas Renais, Doença Crónica Renal, Doenças Renais Crônicas, Doenças do Rim Crônicas, Insuficiência Crônica do Rim, Insuficiência do Rim Crônica
Spanish Deterioro renal crónico, Fallo renal crónico, enfermedad renal crónica, Enfermedad Crónica Renal, Insuficiencias Crónicas del Riñón, Enfermedades Crónicas Renales, Insuficiencia Crónica Renal, Enfermedad Crónica del Riñón, Enfermedad del Riñón Crónica, Enfermedades Crónicas del Riñón, Enfermedades Renales Crónicas, Insuficiencia Crónica del Riñón, Insuficiencias Crónicas Renales, Insuficiencias Renales Crónicas, Insuficiencias del Riñón Crónicas, Enfermedad Renal Crónica, Enfermedades del Riñón Crónicas, insuficiencia renal crónica, síndrome de insuficiencia renal crónica (trastorno), insuficiencia renal crónica (trastorno), síndrome de insuficiencia renal crónica, disfunción renal crónica (trastorno), disfunción renal crónica, Insuficiencia del Riñón Crónica, Insuficiencia Renal Crónica
Japanese 慢性腎機能障害, 慢性腎機能不全, マンセイジンキノウフゼン, マンセイジンキノウショウガイ, 慢性腎疾患, 腎臓病-慢性, 慢性腎臓病
Swedish Njurfunktionsförsämring, kronisk
Czech renální insuficience chronická, ledviny - chronická nedostatečnost, Chronická renální nedostatečnost, Chronické renální poškození
Finnish Munuaisten pitkäaikainen vajaatoiminta
English chronic renal insufficiency (diagnosis), chronic renal insufficiency, Chronic renal disease, Chronic kidney disease, Renal Insufficiency, Chronic [Disease/Finding], CKD - chronic kidney disease, Chronic renal insufficiency, Chronic renal impairment, Chronic renal impairment (disorder), insufficiency; renal, chronic, end stage renal disease, insufficiency; renal, chronic, insufficiency; renal, end stage, kidney; insufficiency, chronic, Chronic Kidney Insufficiency, Kidney Insufficiency, Chronic, Renal Insufficiency, Chronic, Chronic Kidney Insufficiencies, Chronic Renal Insufficiencies, Chronic Renal Insufficiency, Kidney Insufficiencies, Chronic, Renal Insufficiencies, Chronic
Polish Zaburzenia czynności nerek przewlekłe, Niedomoga nerkowa przewlekła, Niewydolność nerek przewlekła
Hungarian Chronikus veseelégtelenség, Chronikus renalis károsodás
Norwegian Kronisk nyreinsuffisiens
Croatian Renalna insuficijencija, kronična

Ontology: Renal Insufficiency (C1565489)

Definition (MSH) Conditions in which the KIDNEYS perform below the normal level in the ability to remove wastes, concentrate URINE, and maintain ELECTROLYTE BALANCE; BLOOD PRESSURE; and CALCIUM metabolism. Renal insufficiency can be classified by the degree of kidney damage (as measured by the level of PROTEINURIA) and reduction in GLOMERULAR FILTRATION RATE.
Concepts Disease or Syndrome (T047)
MSH D051437
SnomedCT 197657007, 236423003
Italian Danno renale, Insufficienza dei reni, Funzionalità renale ridotta, Danno renale NAS, Insufficienza renale
Dutch renale insufficiëntie, nierfunctie verminderd NAO, afgenomen nierfunctie, insufficiëntie; nier, nier; insufficiëntie, nierfunctie verminderd
French Troubles de la fonction rénale, Atteinte de la fonction rénale SAI, Insuffisance du rein, Atteinte de la fonction rénale, Insuffisance rénale
German Insuffizienz der Niere, Niereninsuffizienz NNB, beeintraechtigte Nierenfunktion, Nierenfunktionsbeeintraechtigung, Niereninsuffizienz, Renale Insuffizienz
Portuguese Compromisso renal NE, Insuficiência renal, Função renal insuficiente, Compromisso renal, Insuficiência Renal, Insuficiência do Rim
Spanish Fallo renal, Alteración renal NEOM, Función renal alterada, Insuficiencia renal, Insuficiencia del Riñón, compromiso de la función renal, disfunción renal (trastorno), disfunción renal, fallo renal, Alteración renal, Insuficiencia Renal
Japanese 腎機能不全, 腎機能障害NOS, ジンキノウフゼン, ジンキノウショウガイ, ジンキノウショウガイNOS, 腎機能障害, 腎機能異常, 腎機能低下
Swedish Njurfunktion, nedsatt
Czech ledviny - nedostatečnost, renální insuficience, Renální poškození, Renální postižení NOS, Renální insuficience, Renální nedostatečnost
Finnish Munuaisten pitkäaikainen vajaatoiminta
English renal insufficiency, renal insufficiency (diagnosis), Renal impairment NOS, Renal Insufficiency [Disease/Finding], Insufficiency;renal, kidney insufficiency, renal insufficiencies, impaired renal function, impairments renal, function impaired renal, impairment renal, renal impairment, Renal insufficiency, Impaired renal function, Renal impairment, Renal impairment (disorder), insufficiency; renal, kidney; insufficiency, Insufficiency renal, Kidney Insufficiency, Kidney Insufficiencies, Renal Insufficiencies, Insufficiency, Kidney, Renal Insufficiency
Polish Niedomoga nerek, Zaburzenia czynności nerek, Niewydolność nerek
Hungarian Károsodott vesefunkció, vesekárosodás k.m.n., Veseelégtelenség, vesekárosodás
Norwegian Nyreinsuffisiens, Nyrefunksjon, nedsatt
Croatian Renalna insuficijencija, Zatajivanje bubrega

Ontology: Chronic kidney disease stage 5 (C2316810)

Definition (NCI) Long-standing and persistent renal disease with glomerular filtration rate (GFR) less than 15 ml/min.
Definition (NCI_FDA) Chronic, irreversible renal failure.
Concepts Disease or Syndrome (T047)
ICD10 N18.6 , N18.5
SnomedCT 433146000
LNC LP128701-2, LP135358-2, MTHU040642
English End Stage Kidney Disease, End Stage Kidney Failure, End Stage Renal Failure, chronic kidney disease stage 5 (diagnosis), chronic kidney disease stage 5, Chronic kidney disease stage 5 (disorder), chronic kidney disease, stage 5, Chronic Kidney Disease, Stage 5, End Stage Renal Disease, Chronic kidney disease stage 5, End stage renal disease, CKD stage 5, Chronic kidney disease, stage 5, End-Stage Renal Disease, End-stage renal disease, RENAL DISEASE, END STAGE, END STAGE RENAL DISEASE (ESRD), DISEASE (ESRD), END STAGE RENAL, RENAL DISEASE (ESRD), END STAGE, ESRD, END STAGE RENAL DISEASE, ESRD
Spanish enfermedad renal crónica, estadio 5 (trastorno), enfermedad renal crónica estadio 5, enfermedad renal crónica estadio 5 (trastorno), enfermedad renal crónica, estadio 5

Ontology: Chronic kidney disease (SMQ) (C3544363)

Definition (MDRCZE) Chronické renální onemocnění (CKD) je heterogenní skupina stavů postihujících strukturu a funkci ledvin. Mezi příznaky patří: anorexie, nauzea, zvracení, stomatitida, porucha chuti, nykturie, malátnost, únava, svědění, snížení duševní čilosti, svalové záškuby a křeče, retence tekutin, podvýživa, gastrointestinální vředy a krvácení, periferní neuropatie a záchvaty. Diagnóza je založena na laboratorním vyšetření renálních funkcí a někdy na renální biopsii. Léčba je zaměřena na základní onemocnění, ale zahrnuje též korekce hydratace a elektrolytů, aplikace erytropoetinu při anémii, dialýzu nebo transplantaci. CKD může vzniknout z různých příčin zahrnujících: vaskulární choroby; primární a sekundární glomerulopatie; tubulointersticiální onemocnění; obstrukce močových cest. Známky poškození ledvin zahrnují kromě proteinurie též abnormality močového sedimentu a abnormality zobrazovacích vyšetření. Dvěma hlavními důsledky CKD jsou pokles renální funkce vedoucí k selhání a rozvoj kardiovaskulárních nemocí. Vysoký krevní tlak může být příčinou i komplikací chronického onemocnění ledvin a je spojen s rychlejší ztrátou funkce ledvin a rozvojem kardiovaskulárních onemocnění. Dalšími komplikacemi jsou anémie, malnutrice, renální kostní nemoc s poruchami kalcio-fosfátového metabolizmu a neuropatie. Kritéria pro diagnózu CKD podle National Kidney Foundation jsou: renální poškození trvající min. 3 měsíce (strukturální nebo funkční abnormality) s nebo bez snížené glomerulární filtrace, manifestované buď patologickými abnormalitami nebo markery renálního poškození (odchylky vyšetření krve a moči nebo abnormality zobrazovacích vyšetření) a glomerulální filtrace <60 mL/min/1.73m2 trvající min. 3 měsíce, s nebo bez renálního poškození.
Definition (MDRDUT) Chronische nieraandoening is een heterogene groep aandoeningen met invloed op de structuur en werking van de nieren. De symptomen zijn o.a.: anorexie, misselijkheid, braken, stomatitis, dysgeusie, nycturie, matheid, vermoeidheid, pruritus, verminderde geestelijke scherpheid, spiertrekkingen en krampen, waterretentie, ondervoeding, gastro-intestinale ulceratie en bloeding, perifere neuropathieën en insulten. De diagnose is gebaseerd op laboratoriumonderzoek van de nierfunctie en soms op nierbiopsieën. Behandeling is gericht op de onderliggende aandoening, maar omvat vloeistofen elektrolytenmanagement, erytropoëtine voor bloedarmoede, dialyse of transplantatie. Chronische nieraandoening kan het gevolg zijn van een aantal oorzaken, waaronder: vaataandoening; primaire en secundaire glomerulaire aandoeningen; tubulo-interstitiële ziekte; en obstructie van de urinewegen. Markers van nierbeschadiging naast proteïnurie zijn onder meer afwijkingen in urinesediment en afwijkingen in beeldvormingsonderzoeken. Twee belangrijke eindresultaten van chronische nieraandoening zijn: verlies van nierfunctie die tot falen leidt; ontwikkeling van harten vaatziekte. Hoge bloeddruk is zowel oorzaak als complicatie van chronische nieraandoening en gaat gepaard met sneller verlies van nierfunctie en de ontwikkeling van harten vaatziekte. Aanvullende complicaties zijn: bloedarmoede; ondervoeding; botziekte en aandoeningen van het calciumen fosformetabolisme; neuropathieën. Criteria voor chronische nieraandoening, vastgesteld door de National Kidney Foundation, zijn: nierbeschadiging gedurende = 3 maanden (structurele of functionele afwijkingen) met of zonder verlaagde glomerulaire filtratiesnelheid gemanifesteerd door ofwel pathologische afwijkingen of markers van nierbeschadiging (afwijkingen van urine of bloed, of afwijkingen bij beeldvormingsonderzoek); en glomerulaire filtratiesnelheid < 60 ml/min/1,73 m2 gedurende = 3 maanden, met of zonder nierbeschadiging.
Definition (MDRFRE) La Maladie rénale chronique (Chronic renal disease = CKD) regroupe les affections hétérogènes atteignant la structure et la fonction rénale. Les symptômes incluent : anorexie, nausées, vomissements, stomatite, dysgueusie, nycturie, lassitude, fatigue, prurit, diminution des fonctions mentales, contractions fasciculaires et crampes musculaires, rétention hydrique, sous-alimentation, ulcération et saignement gastro-intestinal, neuropathies périphériques et convulsions. Le diagnostic est basé sur les tests biologiques de la fonction rénale et quelquefois de la biopsie rénale. Le traitement est dirigé vers la cause sous-jacente et inclut la gestion des fluides et des électrolytes, l'érythropoiétine pour l'anémie, la dialyse ou la greffe. La maladie rénale chronique peut résulter d'un certain nombre de causes: maladie vasculaire; maladie glomérulaire, primitive ou secondaire; maladie tubulo-interstitielle ou obstruction des voies urinaires. Les marqueurs de lésions rénales autres que la protéinurie sont des anomalies du sédiment urinaire et des anomalies d'imagerie. Deux évolutions majeures de la maladie rénale chronique incluent : Perte de la fonction rénale et développement de maladies cardio-vasculaires. La pression sanguine élevée est à la fois une cause et une complication de la maladie rénale chronique et est associée à la perte de la fonction rénale et au développement de maladies cardio-vasculaires. Les autres complications incluent : une anémie; une malnutrition; des maladies osseuse et désordres du métabolisme du calcium et du phosphore; des neuropathies. Les critères de la "Kidney Foundation" sont : Atteinte rénale égale ou supérieure à 3 mois (anomalies structurelles ou fonctionnelles) avec ou sans diminution du débit de filtration glomérulaire manifestée soit par des anomalies pathologiques ou des marqueurs d'atteinte rénale (urinaires ou sanguines ou anomalies de l'imagerie) et un débit de filtration glomérulaire <60mL/mn/1,73m2 depuis 3 mois.
Definition (MDRGER) Chronische Nierenerkrankung (CNE) ist eine heterogene, die Nierenstrukturen undfunktion betreffende Gruppe von Erkrankungen. Symptome beziehen ein: Anorexie, Übelkeit, Erbrechen, Stomatitis, Dysgeusie, Nykturie, Mattigkeit, Ermüdung, Pruritus, verringerte Denkfähigkeit, Muskelzucken undkrämpfe, Wasserretention, Unterernährung, Ulkus und Blutung gastrointestinal, periphere Neuropathien sowie Anfälle. Diagnose basiert auf Laboruntersuchungen der Nierenfunktion, in manchen Fällen auf der Nierenbiopsie. Die Behandlung richtet sich nach dem zugrundeliegenden Zustand, beinhaltet aber auch die Flüssigkeitsund Elektrolytenkontrolle, Erythropoietin bei Anämie, Dialyse oder Transplantation. CNE kann eine Reihe von Ursachen haben, einschließlich: Gefäßerkrankung; primäre und sekundäre glomeruläre Erkrankungen; tubulointerstitielle Erkrankung; Obstruktion des Harnapparats. Marker für Nierenschäden zusätzlich zur Proteinurie beziehen ein: Urinsedimentanomalien; Anomalien bei bildgebenden Untersuchungen. Zwei Hauptergebnisse von CNE beziehen ein: zum Versagen führender Verlust der Nierenfunktion; Entwicklung kardiovaskulärer Erkrankung. Hoher Blutdruck stellt sowohl eine Ursache als auch eine Komplikation von CNE dar und wird mit dem rapideren Verlust der Nierenfunktion und der Entwicklung einer kardiovaskulären Erkrankung assoziiert. Weitere Komplikationen beziehen ein: Anämie; Mangelernährung; Knochenerkrankungen und Störungen des Kalziumund Phosphorstoffwechsels; Neuropathien. Von der National Kidney Foundation erstellte CNE-Kriterien sind: Nierenschaden für =3 Monate (strukturelle bzw. funktionelle Anomalien), mit oder ohne erniedrigter glomerulärer Filtrationsrate, präsentiert entweder als pathologische Anomalien oder als Anzeichen von Nierenschaden (Urinoder Blutanomalien oder Anomalien bei bildgebenden Untersuchungen); und glomeruläre Filtrationsrate <60 ml/Min./1,73 m2 für =3 Monate, mit oder ohne Nierenschaden.
Definition (MDRHUN) A krónikus vesebetegség (CKD) a vese struktúráját és funkcióját érintő rendellenességek heterogén csoportja. Tünetei többek között: anorexia, nausea, hányás, stomatitis, dysgeusia, nocturia, lankadtság, fáradtság, pruritus, csökkent mentális képességek, izomrángások és görcsök, vízvisszatartás, alultápláltság, gastrointestinális ulceratio és vérzés, perifériás neuropathiák és görcsrohamok. A diagnózis a vesefunkció laborvizsgálatain és esetenként vesebiopszián alapul. A kezelés az alapbetegséget célozza, de idetartozik a folyadékés sóháztartás kezelése, eryhtropoietin az anemiára, dialízis és transzplantáció. A CKD számos ok miatt kialakulhat, többek között: vaszkuláris betegség, elsődleges és másodlagos glomeruláris betegség; tubulointersitiális betegség; és a húgyvezeték elzáródása. A vesekárosodás jelei a proteinuria mellett többek között vizelet szedimentációs rendellenességek és képalkotási vizsgálatokkal tapasztalható rendellenességek. A CKD két jelentős kimenetele közé tartozik: a vesefunkció elégtelenséghez vezető csökkenése és kardiovaszkuláris betegség kialakulása. A magas vérnyomás a krónikus vesebetegség oka és következménye is lehet egyben, amihez gyorsabb lefolyású vesefunkció vesztés és kardiovaszkuláris betegség is társul. A további komplikációkhoz tartozik: anemia, táplálkozási zavar, csontbetegség, a kalcium és foszfor metabolizmus rendellenességei és a neuropathiák. A CKD diagnózisának kritériumai a Nemzeti Vese Alapítvány (National Kidney Foundation) meghatározása alapján: vesekárosodás legalább 3 hónapig (struktúrális és funkcionális rendellenességek) csökkent glomerularis filtrációs rátával vagy anélkül, melyet patológiás rendellenességek és különböző vesekárosodásra utaló markerek jellemeznek (vizelet vagy vér rendellenességek vagy a képalkotó eljárásokkal végzett vizsgálatokkal tapasztalható rendellenességek); továbbá kisebb mint 60 ml/min/1,73m2 glomerularis filtrációs ráta legalább 3 hónapig, vesekárosodással vagy vesekárosodás nélkül.
Definition (MDRITA) La nefropatia cronica è un gruppo eterogeneo di disturbi che colpisce la struttura e la funzionalità del rene. I sintomi includono: anoressia, nausea, vomito, stomatite, disgeusia, diuresi notturna, stanchezza, spossatezza, prurito, diminuzione dell'acutezza mentale, crampi e spasmi muscolari, ritenzione idrica, sottonutrizione, ulcerazione sanguinamento gastrointestinale, neuropatie periferiche e convulsioni. La diagnosi si basa sui test di laboratorio della funzionalità renale e talvolta sulla biopsia renale. La terapia è mirata alla condizione soggiacente, ma include la gestione dei liquidi e degli elettroliti, l'eritropoietina per l'anemia, la dialisi e il trapianto. La nefropatia cronica può essere il risultato di cause diverse, fra cui: vasculopatia, malattie glomerulari primarie e secondarie, malattia tubulo-interstiziale e ostruzione delle vie urinarie. I segni della malattia renale, oltre alla proteinuria, includono le alterazioni del sedimento urinario e le anomalie negli esami di imaging. Due esiti importanti della nefropatia cronica sono: perdita della funzionalità renale con successiva insufficienza e sviluppo di malattie cardiovascolari. L'ipertensione è allo stesso tempo una causa e una complicanza della nefropatia cronica ed è associata ad una perdita più rapida della funzionalità renale e allo sviluppo di malattie cardiovascolari. Altre complicazioni includono: anemia, malnutrizione, malattia dell'osso e disturbi del metabolismo del calcio e del fosforo e neuropatie. I criteri per la nefropatia cronica stabiliti dal National Kidney Foundation sono: danno al rene per =3 mesi (alterazioni strutturali o funzionali) con o senza una diminuzione della velocità di filtrazione glomerulare manifestato da anomalie patologiche o segni di danno renale (alterazioni urinarie o ematiche o anomalie negli esami di imaging) e velocità di filtrazione glomerulare <60 ml/min/1,73m2 per =3 mesi, con o senza danno renale.
Definition (MDRPOR) A doença renal crónica (DRC) pertence a um grupo heterogéneo de doenças que afectam a estrutura e a função renal. Os sintomas incluem: anorexia, náusea, vómitos, estomatite, disgeusia, nícturia, lassitude, fadiga, prurido, acuidade mental diminuída, fasciculações e cãibras musculares, retenção de água, subnutrição, ulceração e hemorragia gastrointestinal, neuropatias periféricas e crises. O diagnóstico baseia-se em testes laboratoriais da função renal e, por vezes, biopsia renal. O tratamento incide sobre a doença subjacente, mas inclui o controlo de líquidos e de electrólitos, eritropoietina para anemia, diálise ou transplantação. A DRC pode resultar de muitas causas que incluem: doença vascular; doenças glomerulares primárias e secundárias; doença tubulointersticial; e obstrução das vias urinárias. Os marcadores de lesão renal além da proteinúria incluem anomalias do sedimento urinário e anomalias nos estudos de imagiologia. Os dois principais resultados da DRC incluem: perda de função renal que causa insuficiência; e desenvolvimento de doença cardiovascular. A pressão arterial elevada é tanto uma causa como uma complicação da DRC e está associada a uma perda mais rápida da função renal e ao desenvolvimento de doença cardiovascular. Complicações adicionais incluem: anemia; subnutrição; doença óssea e distúrbios do metabolismo do cálcio e do fósforo; e neuropatias. Critérios para a DRC estabelecidos pela National Kidney Foundation (Fundação Nacional do Rim) são: lesão renal durante =3 meses (anomalias estruturais ou funcionais) com ou sem taxa de filtração glomerular diminuída manifestada quer por anomalias patológicas ou marcadores de lesão renal (anomalias na urina ou no sangue, ou anomalias em testes de imagiologia); e taxa de filtração glomerular <60 mL/min/1,73m2 durante =3 meses, com ou sem lesão renal.
Definition (MDRSPA) La enfermedad renal crónica (ERC) es un trastorno heterogéneo que afecta la estructura y función del riñón. Los síntomas incluyen: anorexia, náuseas, vómitos, estomatitis, disgeusia, nicturia, lasitud, fatiga, prurito, agudeza mental disminuida, fasciculación y calambres musculares, retención de agua, hiponutrición, ulceración y sangrado gastrointestinal, neuropatías periféricas y convulsiones. El diagnóstico se basa en pruebas analíticas de la función renal y a veces en biopsia renal. El tratamiento se dirige a la enfermedad subyacente pero incluye el control de líquidos y electrolitos, eritropoyetina para la anemia, diálisis o trasplante. La ERC puede derivar de muchas causas que incluyen: enfermedad vascular; enfermedades glomerulares primarias y secundarias; enfermedad túbulo-intersticial; y obstrucción del tracto urinario. Los marcadores de daño renal además de proteinuria incluyen anomalías en sedimento urinario y anomalías en estudios de imagenología. Las dos principales consecuencias de la ERC incluyen: pérdida de la función renal que deriva en insuficiencia; y desarrollo de enfermedad cardiovascular. La presión arterial alta es tanto una causa como una complicación de la ERC y está asociada a una pérdida más rápida de la función renal y al desarrollo de enfermedad cardiovascular. Las complicaciones adicionales incluyen: anemia; desnutrición; enfermedad ósea y alteraciones en el metabolismo del calcio y fósforo; y neuropatías. Criterios establecidos por la Fundación Nacional del Riñón para la ERC: daño renal durante =3 meses (anomalías estructurales o funcionales) con o sin tasa de filtrado glomerular disminuida manifestado ya sea por anomalías patológicas o marcadores de daño renal (anomalías en orina o sangre, o anomalías en pruebas de imagenología); y tasa de filtración glomerular <60 mL/min/1,73 m2 durante =3 meses, con o sin daño renal.
Definition (MDR) Chronic kidney disease (CKD) is a heterogeneous group of disorders affecting kidney structure and function. Symptoms include: anorexia, nausea, vomiting, stomatitis, dysgeusia, nocturia, lassitude, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, water retention, undernutrition, gastrointestinal ulceration and bleeding, peripheral neuropathies, and seizures. Diagnosis is based on laboratory testing of renal function and sometimes renal biopsy. Treatment directed at the underlying condition but includes fluid and electrolyte management, erythropoietin for anemia, dialysis or transplantation. CKD may result from a number of causes including: vascular disease; primary and secondary glomerular diseases; tubulointerstitial disease; and urinary tract obstruction. Markers of kidney damage in addition to proteinuria include urine sediment abnormalities and abnormalities on imaging studies. Two major outcomes of CKD include: loss of kidney function leading to failure; and development of cardiovascular disease. High blood pressure is both a cause and a complication of CKD and is associated with a faster loss of kidney function and development of cardiovascular disease. Additional complications include: anemia; malnutrition; bone disease and disorders of calcium and phosphorus metabolism; and neuropathies. Criteria for CKD established by the National Kidney Foundation are: kidney damage for =3 months (structural or functional abnormalities) with or without decreased glomerular filtration rate manifested by either pathological abnormalities or markers of kidney damage (urine or blood abnormalities, or abnormalities in imaging tests); and glomerular filtration rate <60 mL/min/1.73m2 for =3 months, with or without kidney damage.
Definition (MDRJPN) 慢性腎臓病(CKD)は、腎臓の構造や機能に影響を及ぼす種々の異なった障害のグループである。以下の症状が含まれる:食欲不振、悪心、嘔吐、口内炎、味覚障害、夜間頻尿、倦怠感、疲労感、そう痒症、知力の低下、筋攣縮や筋痙攣、水分貯留、栄養不良、消化管潰瘍や出血、末梢性ニューロパチー、痙攣発作。診断は、腎機能の臨床検査、時には腎生検に基づく。治療は、直接、基礎疾患に対しおこなうが、体液および電解質の管理、貧血に対するエリスロポエチン療法、透析や移植が含まれる。慢性腎臓病(CKD)は、以下の多くの原因で生じ得る:心血管障害;原発性糸球体疾患および二次性糸球体疾患;尿細管間質性疾患;尿路閉塞。タンパク尿に加えて、腎損傷のマーカーは、尿沈渣異常、画像所見異常を含む。 CKDの二つの主要な転帰は次のとおり、腎不全につながる腎機能の喪失、心血管疾患の進行。高血圧は、CKDの原因であり、合併症でもあり、より速い腎機能の喪失、心血管疾患の進行に関連する。その他の合併症は:貧血、栄養障害、骨疾患とカルシウムとリン代謝の障害および神経障害。国立腎臓財団が定めた慢性腎臓疾患(CKD)の診断基準は、糸球体濾過率の低下の有無に関わらず病理学的または腎臓損傷のマーカー(尿、または血液の異常、または画像検査における異常)の異常を伴う3か月を超える期間の腎の構造または機能の損傷、あるいは、腎臓の損傷の有無に関わらず糸球体濾過率が3か月以上60 mL/min/1.73m2 未満、に該当するもの
Concepts Classification (T185)
English Chronic kidney disease (SMQ)
Czech Chronické renální onemocnění (SMQ)
Dutch Chronische nieraandoening (SMQ)
French Maladie rénale chronique (SMQ)
German Chronische Nierenerkrankung (SMQ)
Hungarian Chronikus vesebetegség (SMQ)
Italian Nefropatia cronica (SMQ)
Japanese 慢性腎臓病(SMQ)
Portuguese Doença renal crónica (SMQ)
Spanish Enfermedad renal crónica (SMQ)