← Diagnosis and Management Guides
Chronic Kidney Disease Management
Key considerations: Rapidly progressive GN, Reversible causes of CKD decline, Uremic emergency
Cannot miss
- Rapidly progressive GN
- Reversible causes of CKD decline
- Uremic emergency
Likely diagnoses
- Diabetic nephropathy
- Hypertensive nephrosclerosis
- Glomerulonephritis
- PCKD
- Obstructive uropathy
Red flags
- Rapid GFR decline (>5mL/min/year)
- Refractory hyperkalemia
- Severe metabolic acidosis
- Uremic symptoms (pericarditis, encephalopathy, bleeding)
Workup
- history: Etiology, medication review, symptoms of uremia, volume status; exam: Blood pressure, volume status, peripheral edema; labs: BMP, CBC, phosphorus, calcium, PTH, albumin, lipids, HbA1c, UACR; imaging: Renal ultrasound at diagnosis; bedside: Blood pressure measurement
Management
- immediate: Stage 4-5: nephrology referral, dialysis access planning; general: ACEi/ARB for proteinuria and BP control; SGLT2 inhibitor (dapagliflozin, empagliflozin) — slows CKD progression; BP target <130/80; Statin for cardiovascular risk; Phosphate binders, vitamin D, EPO as needed; Avoid nephrotoxins (NSAIDs, contrast, aminoglycosides); Medication dose adjustments
Disposition
- admit: Uremic emergency, severe electrolyte derangements, need for urgent dialysis; discharge: Stable CKD with nephrology co-management; consults: Nephrology for Stage 4+, vascular surgery for access planning
Clinical pearls
- SGLT2 inhibitors reduce CKD progression by 30-40% regardless of diabetes status — game-changing
- Metabolic acidosis in CKD: sodium bicarbonate supplementation slows GFR decline
- Avoid NSAIDs, minimize contrast exposure, and dose-adjust all renally cleared medications
Source and review
- KDIGO CKD Guidelines 2024. Last reviewed: 2024-11-01