Chronic Kidney Disease Clinical Presentation

  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Mar 28, 2012
 

History

Patients with chronic kidney disease stages 1-3 (glomerular filtration rate [GFR] >30 mL/min) are generally asymptomatic; they do not experience clinically evident disturbances in water or electrolyte balance or endocrine/metabolic derangements. Generally, these disturbances become clinically manifest with chronic kidney disease stages 4-5 (GFR < 30 mL/min).

Uremic manifestations in patients with chronic kidney disease stage 5 are believed to be primarily secondary to an accumulation of toxins, the identity of which is generally not known. Metabolic acidosis in stage 5 may manifest as protein-energy malnutrition, loss of lean body mass, and muscle weakness. Altered salt and water handling by the kidney in chronic kidney disease can cause peripheral edema and, not uncommonly, pulmonary edema and hypertension.

Anemia is associated with fatigue, reduced exercise capacity, impaired cognitive and immune function, and reduced quality of life. Anemia is also associated with the development of cardiovascular disease, the new onset of heart failure, or the development of more severe heart failure. Anemia is associated with increased cardiovascular mortality.

Other manifestations of uremia in ESRD, many of which are more likely in patients who are inadequately dialyzed, include the following:

  • Pericarditis - Can be complicated by cardiac tamponade, possibly resulting in death
  • Encephalopathy - Can progress to coma and death
  • Peripheral neuropathy
  • Restless leg syndrome
  • GI symptoms - Anorexia, nausea, vomiting, diarrhea
  • Skin manifestations - Dry skin, pruritus, ecchymosis
  • Fatigue, increased somnolence, failure to thrive
  • Malnutrition
  • Erectile dysfunction, decreased libido, amenorrhea
  • Platelet dysfunction with tendency to bleeding
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Physical Examination

The physical examination often is not very helpful. However, it may reveal findings characteristic of the condition that is underlying chronic kidney disease (eg, lupus, severe arteriosclerosis, hypertension) or complications of chronic kidney disease (eg, anemia, bleeding diathesis, pericarditis).

Screening for depression

Forty-five percent of patients with chronic kidney disease have depressive symptoms at dialysis therapy initiation, as assessed using self-report scales. However, these scales may emphasize somatic symptoms—specifically, sleep disturbance, fatigue, and anorexia—that can coexist with chronic disease symptoms.

Hedayati et al reported that the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR[16]) and the Beck Depression Inventory (BDI) are effective screening tools and that scores of 10 and 11, respectively, were the best cutoff scores for identification of a major depressive episode in their study's patient population.[13] The study compared the BDI and QIDS-SR(16) with a gold-standard structured psychiatric interview in 272 patients with stage 2-5 chronic kidney disease who had not been treated with dialysis.

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Contributor Information and Disclosures
Author

Pradeep Arora, MD  Assistant Professor of Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences; Attending Nephrologist, Veterans Affairs Western New York Healthcare System

Disclosure: Nothing to disclose.

Specialty Editor Board

Laura Lyngby Mulloy, DO, FACP  Professor of Medicine, Chief, Section of Nephrology, Hypertension, and Transplantation Medicine, Glover/Mealing Eminent Scholar Chair in Immunology, Medical College of Georgia

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

George R Aronoff, MD  Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Mauro Verrelli, MD to the development and writing of the source article.

References

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The tracing shows a wide QRS and very large T waves. In the setting of a minimally symptomatic patient with renal failure, this must be treated as hyperkalemia until the potassium level is not elevated. Hyperkalemia may be completely asymptomatic until a lethal arrhythmia occurs. Calcium salts are the most rapid acting of the agents used to treat hyperkalemia.
 
 
 
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