genitourinary disorders
Chronic Kidney Disease
Key Points
Common causes of chronic kidney disease (CKD) in the United States are diabetic nephropathy (the most common), hypertensive nephrosclerosis, glomerulopathies, and metabolic syndrome. Effects of CKD can include hypocalcemia, hyperphosphatemia, metabolic acidosis, anemia, secondary hyperparathyroidism, and renal osteodystrophy. Distinguish CKD from acute kidney injury based on history, clinical findings, routine laboratory tests, and ultrasonography. Control underlying disorders (eg, diabetes) and BP levels (usually with an ACE inhibitor or ARB). Treat patients with proteinuric CKD with an ACE inhibitor or ARB, plus an SGLT2 inhibitor. Give supplementalvitamin Dand/orsodium bicarbonateand restrict potassium and phosphate as needed. Treat heart failure, anemia, and other complications. Educate patients with advanced CKD on treatment options (dialysis, kidney transplantation, or palliative care) early, to allow adequate time for planning. Initiate dialysis for patients with severely decreased eGFR when signs and symptoms are inadequately controlled with medications and lifestyle interventions. 