Newly identified chronic kidney disease (CKD)

CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; SLE: systemic lupus erythematosus; HCV: hepatitis C virus; HBV: hepatitis B virus.
* CKD is defined by the presence of kidney damage or decreased kidney function for 3 or more months, irrespective of the cause. Kidney damage refers to pathologic abnormalities, whether established with a kidney biopsy or imaging studies, or inferred from markers such as urinary sediment abnormalities or increased rates of urinary albumin excretion. Decreased kidney function refers to a decreased eGFR (eGFR <60 mL/min/1.73 m²).
¶ Dialysis may be needed urgently if a patient with markedly impaired eGFR (ie, eGFR <15 mL/min/1.73 m²) has severe and refractory hyperkalemia, acidosis, or hypervolemia; in addition, severe uremic symptoms (encephalopathy, pericarditis, etc) often warrant initiation of dialysis. Most patients presenting with CKD will not require dialysis at presentation. Refer to UpToDate topic on indications for initiation of dialysis in patients with CKD.
Δ Urinary tract obstruction typically causes decreased eGFR if the obstruction is bilateral; unilateral obstruction may lead to decreased eGFR if the obstructed kidney was the primary functioning kidney, or if both kidneys are damaged due to another disorder such that neither kidney has functional reserve. Kidney ultrasound may also corroborate the presence of CKD (revealing small echogenic kidneys) or may suggest an alternate etiology of CKD, such as cystic kidney disease. Refer to UpToDate topic on radiographic assessment of kidney disease.
◊ Rapid progression is defined as a decrease in eGFR >5 mL/min/1.73 m² over a year (or a corresponding rate of decline over a shorter period of time), or a 25% decline in eGFR from baseline. Rapid progression over 4 to 8 weeks should be viewed as subacute kidney injury and may warrant urgent consultation with nephrology. Refer to UpToDate topic on subacute kidney injury.
§ Consultation with nephrology may result in directed medical management, kidney biopsy, and dialysis planning when indicated.