History

The history should begin by focusing on cause-specific symptoms to determine the source of the chronic kidney disease (CKD) if this is unknown. Recognition of such symptoms facilitates the planning of further workup and management of the disease (if systemic).

The next step is to look for symptoms related to uremia to determine if renal replacement therapy is needed. The following symptoms suggest uremia:

Weakness and fatigue
Loss of energy, appetite, and weight
Pruritus
Early morning nausea and vomiting
Change in taste sensation
Reversal in sleep pattern (ie, sleepiness in daytime and wakefulness at night)
Peripheral neuropathy
Seizures
Tremors

The presence of edema and hypertension suggests volume retention. Dyspnea or chest pain that varies with position suggests fluid overload and pericarditis, respectively. Leg cramps may suggest hypocalcemia or other electrolyte abnormalities. Weakness, lethargy, and fatigue may be due to anemia.

Physical Examination

Cause-specific physical examination findings are discussed elsewhere, in articles describing the specific causes (see Etiology). Uremia-specific physical findings include the following:

Hypertension
Jugular venous distention (if severe volume overload is present)
Pulmonary rales (if pulmonary edema is present)
Pericardial friction rub in pericarditis
Tenderness in the epigastric region or blood in the stool (possible indicators of uremic gastritis or enteropathy)
Decreased sensation and asterixis (indicators of advanced uremia)

Complications

The presence of the following complications generally indicates a need for urgent dialysis:

Metabolic acidosis
Pulmonary edema
Pericarditis
Uremic encephalopathy
Uremic gastrointestinal bleeding
Uremic neuropathy
Severe anemia and hypocalcemia
Hyperkalemia

Differential Diagnoses

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Media Gallery

Renal corpuscle.
Photomicrograph of a kidney biopsy from a patient with crescentic glomerulonephritis showing prominent fibrocellular crescent formation and moderate mesangial proliferation in a glomerulus. Hematoxylin and eosin stain. Image courtesy of Wikipedia.
Membranoproliferative glomerulonephritis (MPGN) type I. Glomerulus with lobular accentuation from increased mesangial cellularity. A segmental increase occurs in the mesangial matrix, and the peripheral capillary walls are thickened (hematoxylin and eosin stained section; original magnification × 250). Courtesy of John A. Minielly, MD.

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Author

Moro O Salifu, MD, MPH, MBA, MACP Associate Professor, Department of Internal Medicine, Chief, Division of Nephrology, Director of Nephrology Fellowship Program and Transplant Nephrology, State University of New York Downstate Medical Center

Moro O Salifu, MD, MPH, MBA, MACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Artificial Internal Organs, American Society of Diagnostic and Interventional Nephrology, American Society of Nephrology, American Society of Transplantation, National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Subodh J Saggi, MD, MPH, FACP, FASN Professor of Medicine (with Tenure), Fellowship Program Director (Nephrology and Nephrology-Critical Care), Medical Director, Pancreas Transplant Program, State University of New York Downstate College of Medicine

Subodh J Saggi, MD, MPH, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, American Society of Transplantation

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Barbara G Delano, MD, MPH, FACP Professor and Chair, Department of Community Health Sciences, School of Public Health, State University of New York Downstate

Barbara G Delano, MD, MPH, FACP is a member of the following medical societies: American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Sigma Xi, The Scientific Research Honor Society

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.

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

Chronic Glomerulonephritis Clinical Presentation

History

Physical Examination

Complications

References

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