Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Chronic Kidney Disease Differential Diagnoses

  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jul 14, 2016
 
 

Diagnostic Considerations

Chronic kidney disease (CKD) can have a variety of different presentations depending on the stage of the disease and its cause, as well as patient factors such as age. A detailed history and physical examination is essential. In addition to routine laboratory studies, the workup should include calculation of the estimated glomerular filtration rate (GFR), measurement of albumin levels, and acquisition of radiologic studies. The differential diagnosis for CKD includes the following conditions, as well as the disorders listed in the next section:

  • Systemic lupus erythematosus
  • Renal artery stenosis
  • Urinary obstruction
  • Wegener granulomatosis

Differentials

Acute Kidney Injury

Alport Syndrome

Autosomal Dominant Polycystic Kidney Disease

Chronic Glomerulonephritis

Diabetic Nephropathy

Goodpasture Syndrome

Multiple Myeloma

Nephrolithiasis

Nephrosclerosis

Rapidly Progressive Glomerulonephritis

 
 
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.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, 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, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

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.

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

Mauro Verrelli, MD, FRCP(C), FACP Assistant Professor, Department of Medicine, Section of Nephrology, University of Manitoba, Canada

Disclosure: Nothing to disclose.

References
  1. O'Hare AM, Choi AI, Bertenthal D, Bacchetti P, Garg AX, Kaufman JS, et al. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol. 2007 Oct. 18(10):2758-65. [Medline].

  2. Lameire N, Van Biesen W. The initiation of renal-replacement therapy--just-in-time delivery. N Engl J Med. 2010 Aug 12. 363(7):678-80. [Medline].

  3. [Guideline] Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003 Jul 15. 139(2):137-47. [Medline].

  4. Waknine Y. Kidney Disease Classification to Include Albuminuria Medscape Medical News. Dec 31 2012. Available at http://www.medscape.com/viewarticle/776940. Accessed: Jan 9 2013.

  5. [Guideline] KDIGO. Kidney Int Supp. Jan 2013;3(1):1-150. [Full Text].

  6. Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011 Nov. 6(11):2567-72. [Medline].

  7. Bash LD, Erlinger TP, Coresh J, Marsh-Manzi J, Folsom AR, Astor BC. Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2009 Apr. 53(4):596-605. [Medline]. [Full Text].

  8. Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, et al. Age and association of kidney measures with mortality and end-stage renal disease. JAMA. 2012 Dec 12. 308(22):2349-60. [Medline]. [Full Text].

  9. de Boer IH. Chronic kidney disease—a challenge for all ages. JAMA. 2012 Dec 12. 308(22):2401-2. [Medline]. [Full Text].

  10. Friedman DJ, Kozlitina J, Genovese G, Jog P, Pollak MR. Population-Based Risk Assessment of APOL1 on Renal Disease. J Am Soc Nephrol. 2011 Nov. 22(11):2098-105. [Medline].

  11. Isakova T, Xie H, Yang W, Xie D, Anderson AH, Scialla J, et al. Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA. 2011 Jun 15. 305(23):2432-9. [Medline]. [Full Text].

  12. Ellis JW, Chen MH, Foster MC, Liu CT, Larson MG, de Boer I, et al. Validated SNPs for eGFR and their associations with albuminuria. Hum Mol Genet. 2012 Jul 15. 21(14):3293-8. [Medline]. [Full Text].

  13. Pattaro C, Köttgen A, Teumer A, et al. Genome-wide association and functional follow-up reveals new loci for kidney function. PLoS Genet. 2012. 8(3):e1002584. [Medline]. [Full Text].

  14. Nordfors L, Luttropp K, Carrero JJ, Witasp A, Stenvinkel P, Lindholm B, et al. Genetic studies in chronic kidney disease: basic concepts. J Nephrol. 2012 Mar-Apr. 25(2):141-9. [Medline].

  15. Su SL, Lu KC, Lin YF, Hsu YJ, Lee PY, Yang HY, et al. Gene polymorphisms of angiotensin-converting enzyme and angiotensin II type 1 receptor among chronic kidney disease patients in a Chinese population. J Renin Angiotensin Aldosterone Syst. 2012 Mar. 13(1):148-54. [Medline].

  16. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014. 9(1):e84943. [Medline]. [Full Text].

  17. United States Renal Data System. Chapter 1: CKD in the General Population. 2015 USRDS annual data report: Epidemiology of Kidney Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2015. [Full Text].

  18. Centers for Disease Control and Prevention. Deaths and Mortality. Available at http://www.cdc.gov/nchs/fastats/deaths.htm.

  19. Centers for Disease Control and Prevention. Prevalence of chronic kidney disease and associated risk factors--United States, 1999-2004. MMWR Morb Mortal Wkly Rep. 2007 Mar 2. 56(8):161-5. [Medline]. [Full Text].

  20. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016. 11 (7):e0158765. [Medline]. [Full Text].

  21. Choi AI, Rodriguez RA, Bacchetti P, Bertenthal D, Hernandez GT, O'Hare AM. White/black racial differences in risk of end-stage renal disease and death. Am J Med. 2009 Jul. 122(7):672-8. [Medline]. [Full Text].

  22. Schold JD, Srinivas TR, Braun WE, et al. The relative risk of overall graft loss and acute rejection among African American renal transplant recipients is attenuated with advancing age. Clin Transplant. 2011 Sep. 25(5):721-30. [Medline].

  23. Hicks PJ, Langefeld CD, Lu L, Bleyer AJ, Divers J, Nachman PH, et al. Sickle cell trait is not independently associated with susceptibility to end-stage renal disease in African Americans. Kidney Int. 2011 Dec. 80(12):1339-43. [Medline].

  24. Wong CS, Pierce CB, Cole SR, Warady BA, Mak RH, Benador NM, et al. Association of proteinuria with race, cause of chronic kidney disease, and glomerular filtration rate in the chronic kidney disease in children study. Clin J Am Soc Nephrol. 2009 Apr. 4(4):812-9. [Medline]. [Full Text].

  25. Norris KC, Agodoa LY. Unraveling the racial disparities associated with kidney disease. Kidney Int. 2005 Sep. 68(3):914-24. [Medline].

  26. United States Renal Data System. 2011 Annual Data Report. Available at http://www.usrds.org/adr.aspx. Accessed: Sept 6, 2012.

  27. Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011 Apr 20. 305(15):1553-9. [Medline].

  28. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec 2. 341(23):1725-30. [Medline].

  29. Suri RS, Larive B, Sherer S, Eggers P, Gassman J, James SH, et al. Risk of vascular access complications with frequent hemodialysis. J Am Soc Nephrol. 2013 Feb. 24(3):498-505. [Medline]. [Full Text].

  30. McNamara D. More frequent dialysis increases risk for complications. February 13, 2013. Medscape Medical News. Available at http://www.medscape.com/viewarticle/779265. Accessed: August 29, 2013.

  31. Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E. Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure. Kidney Int. 2011 Nov. 80(9):970-7. [Medline].

  32. Wald R, Yan AT, Perl J, et al. Regression of left ventricular mass following conversion from conventional hemodialysis to thrice weekly in-centre nocturnal hemodialysis. BMC Nephrol. 2012 Jan 19. 13(1):3. [Medline].

  33. Raphael KL, Wei G, Baird BC, Greene T, Beddhu S. Higher serum bicarbonate levels within the normal range are associated with better survival and renal outcomes in African Americans. Kidney Int. 2011 Feb. 79(3):356-62. [Medline].

  34. Navaneethan SD, Schold JD, Arrigain S, et al. Low 25-Hydroxyvitamin D Levels and Mortality in Non-Dialysis-Dependent CKD. Am J Kidney Dis. 2011 Oct. 58(4):536-43. [Medline]. [Full Text].

  35. Kendrick J, Cheung AK, Kaufman JS, Greene T, Roberts WL, Smits G, et al. Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease. Am J Kidney Dis. 2012 Oct. 60(4):567-75. [Medline]. [Full Text].

  36. Navaneethan SD, Schold JD, Arrigain S, Jolly SE, Jain A, Schreiber MJ Jr, et al. Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. Am J Kidney Dis. 2011 Oct. 58(4):536-43. [Medline]. [Full Text].

  37. Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ. Validation of depression screening scales in patients with CKD. Am J Kidney Dis. 2009 Sep. 54(3):433-9. [Medline].

  38. Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012 Jul 5. 367(1):20-9. [Medline].

  39. Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate?. Clin Chem. 2002 May. 48(5):699-707. [Medline].

  40. Lemoine S, Panaye M, Pelletier C, Bon C, Juillard L, Dubourg L, et al. Cystatin C-Creatinine Based Glomerular Filtration Rate Equation in Obese Chronic Kidney Disease Patients: Impact of Deindexation and Gender. Am J Nephrol. 2016 Jul 12. 44 (1):63-70. [Medline].

  41. [Guideline] Barclay L. ACP Guidelines: Do Not Screen Asymptomatic Adults for CKD. Medscape Medical News. Oct 21 2013. [Full Text].

  42. [Guideline] Barclay L. CKD: ASN Recommends Screening, Rejects ACP Statement. Medscape Medical News. Oct 23 2013. [Full Text].

  43. Qaseem A, Hopkins RH, Sweet DE, et al. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2013 Oct 22. [Medline].

  44. Galbraith LE, Ronksley PE, Barnieh LJ, Kappel J, Manns BJ, Samuel SM, et al. The See Kidney Disease Targeted Screening Program for CKD. Clin J Am Soc Nephrol. 2016 Jun 6. 11 (6):964-72. [Medline].

  45. [Guideline] National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative. Chronic Kidney Disease: Evaluation, Classification, and Stratification. Available at http://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm. Accessed: September 6, 2012.

  46. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar 16. 130(6):461-70. [Medline].

  47. Stevens LA, Schmid CH, Greene T, Zhang YL, Beck GJ, Froissart M, et al. Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis. 2010 Sep. 56(3):486-95. [Medline]. [Full Text].

  48. Silveiro SP, Araújo GN, Ferreira MN, Souza FD, Yamaguchi HM, Camargo EG. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation pronouncedly underestimates glomerular filtration rate in type 2 diabetes. Diabetes Care. 2011 Nov. 34(11):2353-5. [Medline]. [Full Text].

  49. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009 Mar. 20(3):629-37. [Medline]. [Full Text].

  50. Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR, et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ. 2014 Feb 4. 186(2):112-7. [Medline]. [Full Text].

  51. Harrison L. Canada Guidelines Call for Kidney Dialysis Delay. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/820114. Accessed: February 10, 2014.

  52. Hand L. Antihypertensives May Delay Kidney Disease Progression. Medscape Medical News. Dec 16 2013. [Full Text].

  53. Hsu TW, Liu JS, Hung SC, et al. Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia. JAMA Intern Med. 2013 Dec 16. [Medline].

  54. Park M, Hsu CY. An ACE in the hole for patients with advanced chronic kidney disease?. JAMA Intern Med. 2013 Dec 16. [Medline].

  55. Henderson D. Popular Drugs Do Little to Prevent ESRD in Older Patients. Medscape Medical News. Jan 13 2014. [Full Text].

  56. O'Hare AM, Hotchkiss JR, Kurella Tamura M, et al. Interpreting Treatment Effects From Clinical Trials in the Context of Real-World Risk Information: End-Stage Renal Disease Prevention in Older Adults. JAMA Intern Med. 2014 Jan 13. [Medline].

  57. Peralta CA, Norris KC, Li S, et al. Blood Pressure Components and End-stage Renal Disease in Persons With Chronic Kidney Disease: The Kidney Early Evaluation Program (KEEP). Arch Intern Med. 2012 Jan 9. 172(1):41-47. [Medline].

  58. Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD. J Am Soc Nephrol. 2011 Dec. 22(12):2313-21. [Medline].

  59. Levey AS, Adler S, Caggiula AW, et al. Effects of dietary protein restriction on the progression of moderate renal disease in the Modification of Diet in Renal Disease Study. J Am Soc Nephrol. 1996 Dec. 7(12):2616-26. [Medline].

  60. Kasiske BL, Lakatua JD, Ma JZ, Louis TA. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis. 1998 Jun. 31(6):954-61. [Medline].

  61. Fishbane S, Chittineni H, Packman M, Dutka P, Ali N, Durie N. Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial. Am J Kidney Dis. 2009 Oct. 54(4):647-52. [Medline].

  62. Douglas D. Vitamin D Curbs Albuminuria in Kidney Disease. Medscape Medical News. Available at http://www.medscape.com/viewarticle/810806. Accessed: September 16, 2013.

  63. Molina P, Górriz JL, Molina MD, Peris A, Beltrán S, Kanter J, et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant. 2013 Aug 24. [Medline].

  64. Plantinga L, Grubbs V, Sarkar U, et al. Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States. Ann Fam Med. 2011 September-October. 9(5):423-430. [Medline]. [Full Text].

  65. Hallan SI, Orth SR. Smoking is a risk factor in the progression to kidney failure. Kidney Int. 2011 Sep. 80(5):516-23. [Medline].

  66. Busko M. L-thyroxine dampens renal function decline in CKD with SCH. June 19, 2013. Medscape Medical News [serial online]. Available at http://www.medscape.com/viewarticle/806543. Accessed: June 25, 2013.

  67. Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, et al. Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism. Thyroid. 2013 Jun. 23(6):654-61. [Medline]. [Full Text].

  68. US Food and Drug Administration. Safety: Omontys (peginesatide) Injection by Affymax and Takeda: recall of all lots - serious hypersensitivity reactions. February 23, 2013. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm340895.htm.

  69. Shurraw S, Hemmelgarn B, Lin M, Majumdar SR, Klarenbach S, Manns B, et al. Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease: A Population-Based Cohort Study. Arch Intern Med. 2011 Nov 28. 171(21):1920-1927. [Medline].

  70. [Guideline] Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009 Aug. S1-130. [Medline].

  71. London G, Coyne D, Hruska K, Malluche HH, Martin KJ. The new kidney disease: improving global outcomes (KDIGO) guidelines - expert clinical focus on bone and vascular calcification. Clin Nephrol. 2010 Dec. 74(6):423-32. [Medline].

  72. [Guideline] Dasgupta I, Shroff R, Bennett-Jones D, McVeigh G, NICE Hyperphosphataemia Guideline Development Group. Management of hyperphosphataemia in chronic kidney disease: summary of National Institute for Health and Clinical Excellence (NICE) guideline. Nephron Clin Pract. 2013. 124 (1-2):1-9. [Medline]. [Full Text].

  73. Shaman AM, Kowalski SR. Hyperphosphatemia Management in Patients with Chronic Kidney Disease. Saudi Pharm J. 2016 Jul. 24 (4):494-505. [Medline]. [Full Text].

  74. Rizk R. Cost-effectiveness of phosphate binders among patients with chronic kidney disease not yet on dialysis: a long way to go. BMC Nephrol. 2016 Jul 8. 17 (1):75. [Medline]. [Full Text].

  75. Block GA, Wheeler DC, Persky MS, Kestenbaum B, Ketteler M, Spiegel DM, et al. Effects of phosphate binders in moderate CKD. J Am Soc Nephrol. 2012 Aug. 23(8):1407-15. [Medline]. [Full Text].

  76. de Brito-Ashurst I, Varagunam M, Raftery MJ, Yaqoob MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009 Sep. 20(9):2075-84. [Medline]. [Full Text].

  77. Barclay L. CKD: KDIGO Guidelines Recommend Wider Use of Statins. Medscape Medical News. Available at http://www.medscape.com/viewarticle/817504. Accessed: December 16, 2013.

  78. [Guideline] Tonelli M, Wanner C. Lipid Management in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2013 Clinical Practice Guideline. Ann Intern Med. 2013 Dec 10. [Medline].

  79. Piccoli GB, Capizzi I, Vigotti FN, Leone F, D'Alessandro C, Giuffrida D, et al. Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?. BMC Nephrol. 2016 Jul 8. 17 (1):76. [Medline]. [Full Text].

  80. Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010 Dec 8. CD006763. [Medline].

  81. Slagman MC, Waanders F, Hemmelder MH, et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ. 2011 Jul 26. 343:d4366. [Medline]. [Full Text].

  82. Vegter S, Perna A, Postma MJ, et al. Sodium Intake, ACE Inhibition, and Progression to ESRD. J Am Soc Nephrol. 2012 Jan. 23(1):165-73. [Medline].

  83. Goraya N, Simoni J, Jo C, Wesson DE. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney Int. 2012 Jan. 81(1):86-93. [Medline].

  84. Sakaguchi Y, Shoji T, Kawabata H, Niihata K, Suzuki A, Kaneko T, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol. 2011 May. 6(5):995-1000. [Medline]. [Full Text].

Previous
Next
 
Calciphylaxis due to secondary hyperparathyroidism.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.