Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

328 Chronic Kidney Disease

NSAIDS, lithium, cancer chemotherapeutic agents, pamidronate,

lithium, herbal (e.g., some Chinese herbs) remedies

Risk Factors for Progressive Renal Disease

■Age, male gender, diabetes mellitus, hypertension, family his-

tory (pattern of inheritance); African-American, Hispanic, cigarette

smoking, persistent albuminuria, nephrotoxin exposure (e.g., anal-

gesics).

Signs & Symptoms

■May be asymptomatic; symptoms usual when estimated glomerular

filtration rate≤25 mL/min/1.73 m^2

■General: fatigue, malaise, weakness, fever (systemic diseases and

retroperitoneal fibrosis)

■HEENT: headache, visual disturbances, periorbital edema, retinal

changes of hypertensive/diabetic retinopathy, cholesterol emboli,

uremic fetor

■CV and PULM: dyspnea, edema, chest pain, hypertension, hemopt-

ysis, hyperpnea (metabolic acidosis) pulmonary edema

■GI: dysgeusia, anorexia, nausea, vomiting, diarrhea, occult GI hem-

orrhage

■GU: Nocturia, foamy urine, dysuria, hematuria, stranguria, painful

urination, flank or back pain, hypospadias, urethral stricture,

prostate enlargement

■MS: lower extremity edema, bone and articular pain, generalized

muscle wasting and weakness

■NS: encephalopathy: difficulty concentrating, insomnia, daytime

drowsiness, seizures, coma; peripheral neuropathy

■SKIN: pruritus, easy bruising, petechiae, cutaneous infarcts, palpa-

ble purpura, calcinosis

tests

Laboratory

■Basic blood tests:

➣Early disease: estimated GFR <60 ml/min/1.73 m^2 , elevated

serum creatinine, elevated BUN

➣Advanced disease: early disease+hyperkalemia, hypobicar-

bonatemia, hyperphosphatemia, hypocalcemia, hypercalcemia,

hypermagnesemia, elevated serum PTH, decreased serum 1,25

(OH)2 vitamin D3, elevated alkaline phosphatase, normo-

chromic normocytic anemia