Chronic kidney disease

At a Glance

Chronic kidney disease (CKD) is a disease category referring to chronic kidney conditions, with synonyms such as chronic renal disease.

Representative clinical manifestations range widely from an initial asymptomatic or non-specific state to advanced functional decline accompanied by complications.

How the disease works

Causes are diverse and not limited to a single cause, including diabetes, hypertension, glomerular diseases, genetic diseases, and recurrent kidney injury.

When kidney function declines, the regulation of waste products and fluids becomes disrupted, which can also affect electrolyte and acid-base balance, blood pressure, hematopoiesis, and bone metabolism.

Variations in presentation among individuals

Risks and prognosis vary depending on the cause, degree of kidney function decline, proteinuria, blood pressure and blood glucose control, cardiovascular disease, age, and comorbidities.

The broad framework of diagnosis and management

As it progresses, symptoms such as fatigue, edema, loss of appetite, nausea, itching, and dyspnea may appear, but severity or progression cannot be determined by symptoms alone.

Diagnosis involves evaluating estimated glomerular filtration rate (eGFR) through repeated blood tests and assessing albuminuria via urinalysis, in addition to medical history and physical examination, with imaging or etiological tests added as needed.

Current status of treatment

A single abnormal creatinine or urinalysis result cannot confirm a chronic disease; results must be interpreted in conjunction with the timing of the test, hydration status, medications, muscle mass, and inter-laboratory differences.

Management focuses on addressing both the underlying cause and cardiovascular risk, regulating blood pressure, blood glucose, fluid balance, and electrolytes, avoiding nephrotoxic factors, and regularly checking for complications.

When kidney function declines severely to the point where replacement is needed, dialysis or kidney transplantation become the primary treatment options, but these are not immediately required for all CKD patients.

How to read clinical trials

Follow-up involves monitoring test trends, symptoms, changes in medication and diet, and complications; registration of the Kidney BEAM Trial on ClinicalTrials.gov merely indicates that a study exists and does not demonstrate efficacy, approval, or standard of care.

Points to verify during clinical consultations

In clinical practice, one can verify the cause and test trends, estimated glomerular filtration rate (eGFR) and albuminuria, blood pressure and diabetes control, medications and risk of nephrotoxicity, dietary and lifestyle goals, and the possibility of dialysis or transplantation.