Overview
Signs of Chronic Kidney Disease
General Signs
- Sallow complexion
- Leukonychia
- Sarcopaenia
Signs Suggesting a Cause
- Finger prick markings (diabetes)
- Palpable polycystic kidneys
Signs of Complications
- Acidosis - tachypnoea
- Fluid overload - hypertension, raised JVP, sacral / pedal oedema, pulmonary crepitations
- Anaemia - palmar crease pallor, conjunctival pallor
- Uraemia - scratch marks, confusion, asterixis, pericardial rub
Signs of Management
- Haemodialysis - VasCath, arteriovenous fistula, graft
- Peritoneal dialysis - Tenkhoff catheter
- Scars - nephrectomy, renal transplant, parathyroidectomy
- Palpable renal transplant (usually right lower quadrant)
Aetiology
Causes of Chronic Kidney Disease
- Diabetic nephropathy
- Hypertensive nephropathy
- Glomerulonephritis
- Tubulointerstitial disease - analgesic nephropathy, reflux nephropathy
- Congenital disease - polycystic kidney disease
Complications
Complications of Chronic Kidney Disease
Disease-Related
- Acidosis (poor clearance of hydrogen ions)
- Fluid overload
- Electrolyte derangements - hyperkalaemia, hyperphosphataemia
- Cardiovascular disease - hypertension, increased cardiovascular / cerebrovascular risk
- Anaemia (EPO deficiency)
- Mineral bone disease (mediated by FGF23) - secondary hyperparathyroidism, hyperphosphataemia, hypocalcaemia; tertiary hyperparathyroidism
- Uraemia - encephalopathy, uraemic pericarditis
- Malnutrition
Treatment-Related
- Lethargy
- Muscle cramps
- Restless legs syndrome
- Access-related complications - thrombosis, infection
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