Fast Five Quiz: Is Your Knowledge of Chronic Kidney Disease Sufficient?

Vecihi Batuman, MD

Disclosures

April 20, 2018

Forty-five percent of adult patients with CKD have depressive symptoms at initiation of dialysis therapy, as assessed using self-report scales. However, these scales may emphasize somatic symptoms—specifically, sleep disturbance, fatigue, and anorexia—that can coexist with chronic disease symptoms.

A careful physical examination is imperative. It may reveal findings characteristic of the condition that is underlying CKD (eg, lupus, severe arteriosclerosis, hypertension) or its complications (eg, anemia, bleeding diathesis, pericarditis). However, the lack of findings on physical examination does not exclude kidney disease. In fact, CKD is frequently clinically silent, so screening of patients without signs or symptoms at routine health visits is important.

Patients with CKD stages 1-3 (GFR > 30 mL/min/1.73 m²) are frequently asymptomatic; in terms of possible "negative" symptoms related simply to the reduction in GFR, they do not experience clinically evident disturbances in water or electrolyte balance or endocrine/metabolic derangements, unless they also have significant proteinuria.

Generally, these disturbances become clinically manifest at CKD stages 4-5 (GFR < 30 mL/min/1.73 m²). Patients with tubulointerstitial disease, cystic diseases, nephrotic syndrome, and other conditions associated with "positive" symptoms (eg, polyuria, hematuria, edema) are more likely to develop signs of disease at earlier stages.

For more on the presentation and physical examination of patients with CKD, read here.

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