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Chronic Kidney Disease (CKD)

Background Knowledge ๐Ÿง 


  • Chronic kidney disease (CKD) is defined as persistent kidney damage or a glomerular filtration rate (GFR) <60 mL/min/1.73 mยฒ for over 3 months.
  • Progressive condition leading to decreased kidney function over time.


  • Affects approximately 10-15% of the UK adult population.
  • Higher prevalence in older adults.
  • More common in individuals with diabetes, hypertension, and cardiovascular disease.
  • Increased incidence in certain ethnic groups (e.g., South Asian, African Caribbean).


  • Diabetic nephropathy
  • Hypertensive nephrosclerosis
  • Chronic glomerulonephritis
  • Polycystic kidney disease
  • Chronic interstitial nephritis
  • Obstructive uropathy

Clinical Features ๐ŸŒก๏ธ


  • Often asymptomatic in early stages
  • Fatigue and weakness
  • Anorexia and weight loss
  • Nausea and vomiting
  • Pruritus
  • Nocturia and polyuria
  • Oedema


  • Hypertension
  • Oedema (peripheral, pulmonary)
  • Pallor
  • Signs of underlying cause (e.g. diabetic retinopathy)
  • Pericardial friction rub (late-stage)

Investigations ๐Ÿงช


  • Urinalysis: Proteinuria, haematuria
  • Blood tests: Urea, electrolytes, creatinine, eGFR
  • Nephritic screen
  • Imaging: Renal ultrasound, MR renal angio if indicated
  • Kidney biopsy if cause uncertain or rapidly progressing
  • Albumin-creatinine ratio (ACR) or Protein-creatine ratio (PCR) for proteinuria assessment

Management ๐Ÿฅผ


  • Control underlying conditions (diabetes, hypertension).
  • Lifestyle modifications: Diet, exercise, smoking cessation.
  • Consider ACE-inhibitor, SGLT-2-inhibitor, and non-steroidal mineralocorticoid receptor antagonist where indicated.
  • Regular monitoring of kidney function.
  • Dialysis or kidney transplantation in end-stage renal disease.
  • Patient education and support.


  • Cardiovascular disease
  • Anaemia
  • Bone disease (renal osteodystrophy)
  • Electrolyte imbalances (hyperkalaemia, metabolic acidosis)
  • Fluid overload
  • Infections
  • Uraemic complications (pericarditis, encephalopathy)


  • Progressive nature with risk of end-stage renal disease.
  • Prognosis varies with underlying cause and comorbidities.
  • Early detection and management can slow progression.
  • Regular follow-up is essential.

Key points

  • CKD is a common and serious condition.
  • Screen high-risk populations.
  • Manage underlying conditions and risk factors.
  • Regular monitoring and early intervention are crucial.
  • Multidisciplinary approach often required.


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