Persistent reduction in kidney function (eGFR <60) or markers of damage for ≥3 months.
Causes
- • Diabetes
- • Hypertension
- • Glomerulonephritis
- • Polycystic kidney disease
- • Obstruction
Clinical features
- • Often asymptomatic until late
- • Fatigue, oedema, pruritus, nocturia
- • Uraemia: nausea, encephalopathy
Investigations
- • eGFR (CKD-EPI), ACR
- • U&E, Ca, PO₄, PTH, vit D
- • FBC (anaemia), HbA1c, lipids
- • USS renal tract
Diagnosis
- • Stage by eGFR (G1–G5) and ACR (A1–A3)
Management
- • Treat cause; BP <130/80 (ACEi/ARB if proteinuria)
- • SGLT2i if ACR >25 (irrespective of DM)
- • Statin, lifestyle
- • Anaemia: iron then ESA
- • Bone disease: phosphate binder, active vit D
- • Plan RRT when GFR <15 + symptoms
Complications
- • CV disease (main mortality)
- • Anaemia, bone disease
- • Hyperkalaemia, acidosis
- • ESRD
Clinical pearls
- • Avoid NSAIDs, dose-adjust drugs
- • AVF planned when eGFR <20 and progressive
Educational — verify locally.
