Diagnostic approach to the patient with newly identified chronic kidney disease
- Pedram Fatehi, MD, MPH
Pedram Fatehi, MD, MPH
- Assistant Clinical Professor of Medicine
- Stanford University School of Medicine
- Chi-yuan Hsu, MD, MSc
Chi-yuan Hsu, MD, MSc
- Professor of Medicine
- University of California, San Francisco
Patients with kidney disease may have a variety of clinical presentations. Some have symptoms or signs that are directly referable to the kidney (such as hematuria) or to associated extrarenal manifestations (edema, hypertension, signs of uremia). Many patients are asymptomatic and are incidentally found to have an elevated serum creatinine concentration, which has been stable for years.
This topic reviews the evaluation of patients with newly identified chronic kidney disease (CKD).
The evaluation of patients who present with subacute or acute kidney injury (AKI) is discussed elsewhere. (See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Evaluation of acute kidney injury among hospitalized adult patients".)
The management of CKD patients is discussed elsewhere. (See "Evaluation of acute kidney injury among hospitalized adult patients" and "Overview of the management of chronic kidney disease in adults".)
The evaluation of patients with an elevated creatinine of any duration includes:
- Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 2:1.
- Rose BD. Pathophysiology of Renal Disease, 2nd ed., McGraw-Hill, New York 1987. p.41.
- Moghazi S, Jones E, Schroepple J, et al. Correlation of renal histopathology with sonographic findings. Kidney Int 2005; 67:1515.
- Manley JA, O'Neill WC. How echogenic is echogenic? Quantitative acoustics of the renal cortex. Am J Kidney Dis 2001; 37:706.
- Platt JF, Rubin JM, Bowerman RA, Marn CS. The inability to detect kidney disease on the basis of echogenicity. AJR Am J Roentgenol 1988; 151:317.
- Textor SC. Ischemic nephropathy: where are we now? J Am Soc Nephrol 2004; 15:1974.
- Kitamoto Y, Tomita M, Akamine M, et al. Differentiation of hematuria using a uniquely shaped red cell. Nephron 1993; 64:32.
- Köhler H, Wandel E, Brunck B. Acanthocyturia--a characteristic marker for glomerular bleeding. Kidney Int 1991; 40:115.
- Mendu ML, Lundquist A, Aizer AA, et al. Clinical predictors of diagnostic testing utility in the initial evaluation of chronic kidney disease. Nephrology (Carlton) 2016; 21:851.
- MAJOR CAUSES AND CLASSIFICATION OF KIDNEY DISEASE
- Prerenal disease
- Intrinsic renal vascular disease
- Intrinsic glomerular disease
- Intrinsic tubular and interstitial disease
- Obstructive nephropathy
- CLINICAL MANIFESTATIONS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS