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Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years.WEB, What Is Chronic Kidney Disease?,www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/what-is-chronic-kidney-disease, National Institute of Diabetes and Digestive and Kidney Diseases, 19 December 2017, June 2017, Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications can relate to hormonal dysfunction of the kidneys and include (in chronological order) high blood pressure (often related to activation of the renin–angiotensin system), bone disease, and anemia.JOURNAL, Liao MT, Sung CC, Hung KC, Wu CC, Lo L, Lu KC, Insulin resistance in patients with chronic kidney disease, Journal of Biomedicine & Biotechnology, 2012, 691369, 2012, 22919275, 3420350, 10.1155/2012/691369, free, WEB, Kidney Failure,medlineplus.gov/kidneyfailure.html, MedlinePlus, 11 November 2017, en, JOURNAL,www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO%20CKD-MBD%20GL%20KI%20Suppl%20113.pdf, KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), KDIGO: Kidney Disease Improving Global Outcomes, August 2009, Kidney Int, 76, Suppl 113,www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO%20CKD-MBD%20GL%20KI%20Suppl%20113.pdf," title="web.archive.org/web/20161213061302www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO%20CKD-MBD%20GL%20KI%20Suppl%20113.pdf,">web.archive.org/web/20161213061302www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO%20CKD-MBD%20GL%20KI%20Suppl%20113.pdf, 2016-12-13, dead, Additionally CKD patients have markedly increased cardiovascular complications with increased risks of death and hospitalization.JOURNAL, Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY, Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization, The New England Journal of Medicine, 351, 13, 1296–1305, September 2004, 15385656, 10.1056/NEJMoa041031, free, Causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis, and polycystic kidney disease.WEB, What is renal failure?,www.hopkinsmedicine.org/healthlibrary/conditions/kidney_and_urinary_system_disorders/end_stage_renal_disease_esrd_85,P01474, Johns Hopkins Medicine, 18 December 2017, en, Risk factors include a family history of chronic kidney disease. Diagnosis is by blood tests to measure the estimated glomerular filtration rate (eGFR), and a urine test to measure albumin.WEB, Chronic Kidney Disease Tests & Diagnosis,www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis, National Institute of Diabetes and Digestive and Kidney Diseases, 19 December 2017, October 2016, Ultrasound or kidney biopsy may be performed to determine the underlying cause. Several severity-based staging systems are in use.JOURNAL, Summary of Recommendation Statements, Kidney International Supplements, 3, 1, 5–14, January 2013, 25598998, 4284512, 10.1038/kisup.2012.77, BOOK, Ferri FF, Ferri’s Clinical Advisor 2018 E-Book: 5 Books in 1, 2017, Elsevier Health Sciences, 9780323529570, 294–295,books.google.com/books?id=wGclDwAAQBAJ&pg=PA294, en, Screening at-risk people is recommended. Initial treatments may include medications to lower blood pressure, blood sugar, and cholesterol. Angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are generally first-line agents for blood pressure control, as they slow progression of the kidney disease and the risk of heart disease.JOURNAL, Xie X, Liu Y, Perkovic V, Li X, Ninomiya T, Hou W, Zhao N, Liu L, Lv J, Zhang H, Wang H, 6, Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients With CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials, American Journal of Kidney Diseases, 67, 5, 728–41, May 2016, 26597926, 10.1053/j.ajkd.2015.10.011, Systematic Review & Meta-Analysis, free, Loop diuretics may be used to control edema and, if needed, to further lower blood pressure.JOURNAL, Wile D, Diuretics: a review, Annals of Clinical Biochemistry, 49, Pt 5, 419–31, September 2012, 22783025, 10.1258/acb.2011.011281, free, JOURNAL, James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E, 6, 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8), JAMA, 311, 5, 507–20, February 2014, 6485696, 10.1002/14651858.CD011339.pub2, 24352797, NSAIDs should be avoided.WEB, Managing Chronic Kidney Disease,www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/managing, National Institute of Diabetes and Digestive and Kidney Diseases, October 2016, Other recommended measures include staying active, and certain dietary changes such as a low-salt diet and the right amount of protein.{{Vague|date=March 2024|reason= what is “the right amount“?}}WEB, Eating Right for Chronic Kidney Disease {{!, NIDDK |url=https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition |website=National Institute of Diabetes and Digestive and Kidney Diseases |access-date=5 September 2019}} Treatments for anemia and bone disease may also be required.WEB, Anemia in Chronic Kidney Disease,www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/anemia, National Institute of Diabetes and Digestive and Kidney Diseases, 19 December 2017, July 2016, WEB, Mineral & Bone Disorder in Chronic Kidney Disease,www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/mineral-bone-disorder, National Institute of Diabetes and Digestive and Kidney Diseases, 19 December 2017, November 2015, Severe disease requires hemodialysis, peritoneal dialysis, or a kidney transplant for survival.WEB, Kidney Failure,www.niddk.nih.gov/health-information/kidney-disease/kidney-failure, National Institute of Diabetes and Digestive and Kidney Diseases, 11 November 2017, Chronic kidney disease affected 753 million people globally in 2016 (417 million females and 336 million males.)JOURNAL, Bikbov B, Perico N, Remuzzi G, Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study, Nephron, 139, 4, 313–318, 23 May 2018, 29791905, 10.1159/000489897,zenodo.org/record/1283108, free, JOURNAL, Tjempakasari A, Suroto H, Santoso D, Osteoblastogenesis of adipose-derived mesenchymal stem cells in chronic kidney disease patient with regular hemodialysis, Annals of Medicine and Surgery, 84, 104796, December 2022, 36536732, 9758290, 10.1016/j.amsu.2022.104796, In 2015, it caused 1.2 million deaths, up from 409,000 in 1990.JOURNAL, Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 388, 10053, 1459–1544, October 2016, 27733281, 5388903, 10.1016/s0140-6736(16)31012-1, GBD 2015 Mortality Causes of Death Collaborators, JOURNAL, Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal, GBD 2013 Mortality and Causes of Death Collaborators, Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet, 385, 9963, 117–71, January 2015, 25530442, 4340604, 10.1016/S0140-6736(14)61682-2, Table 2, p. 137 {{Open access}} The causes that contribute to the greatest number of deaths are high blood pressure at 550,000, followed by diabetes at 418,000, and glomerulonephritis at 238,000.

Signs and symptoms

File:Uremic frost on forehead and scalp of young Afro-Caribbean male.jpg|thumb| Uremic frostUremic frostCKD is initially without symptoms, and is usually detected on routine screening blood work by either an increase in serum creatinine, or protein in the urine. As the kidney function decreases, more unpleasant symptoms may emerge:JOURNAL, Kalantar-Zadeh K, Lockwood MB, Rhee CM, Tantisattamo E, Andreoli S, Balducci A, Laffin P, Harris T, Knight R, Kumaraswami L, Liakopoulos V, Lui SF, Kumar S, Ng M, Saadi G, Ulasi I, Tong A, Li PK, Patient-centred approaches for the management of unpleasant symptoms in kidney disease, Nat Rev Nephrol, 18, 2, 001–017, Jan 3, 2022, 34980890, 10.1038/s41581-021-00518-z, 245636182, free,

• Blood pressure is increased due to fluid overload and production of vasoactive hormones created by the kidney via the renin–angiotensin system, increasing the risk of developing hypertension and heart failure. People with CKD are more likely than the general population to develop atherosclerosis with consequent cardiovascular disease, an effect that may be at least partly mediated by uremic toxins.JOURNAL, Hoyer FF, Nahrendorf M, Uremic Toxins Activate Macrophages, Circulation, 139, 1, 97–100, January 2019, 30592654, 6394415, 10.1161/CIRCULATIONAHA.118.037308, {{medrs|date=April 2020}} People with both CKD and cardiovascular disease have significantly worse prognoses than those with only cardiovascular disease.JOURNAL, Damman K, Valente MA, Voors AA, O’Connor CM, van Veldhuisen DJ, Hillege HL, Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis, European Heart Journal, 35, 7, 455–69, February 2014, 24164864, 10.1093/eurheartj/eht386, free,
• Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy). Due to its high systemic concentration, urea is excreted in eccrine sweat at high concentrations and crystallizes on skin as the sweat evaporates (“uremic frost“).
• Potassium accumulates in the blood (hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias). Hyperkalemia usually does not develop until the glomerular filtration rate falls to less than 20–25 mL/min/1.73 m2, when the kidneys have decreased ability to excrete potassium. Hyperkalemia in CKD can be exacerbated by acidemia (triggering the cells to release potassium into the bloodstream to neutralize the acid) and from lack of insulin.JOURNAL, Arora P, Aronoff GR, Mulloy LL, Talavera F, Verrelli M, Batuman V,emedicine.medscape.com/article/238798-overviewaw2aab6b2b2, Chronic Kidney Disease, Medscape, 2018-09-16,
• Fluid overload symptoms may range from mild edema to life-threatening pulmonary edema.
• Hyperphosphatemia results from poor phosphate elimination in the kidney, and contributes to increased cardiovascular risk by causing vascular calcification.JOURNAL, Hruska KA, Mathew S, Lund R, Qiu P, Pratt R, Hyperphosphatemia of chronic kidney disease, Kidney International, 74, 2, 148–57, July 2008, 18449174, 2735026, 10.1038/ki.2008.130, Circulating concentrations of fibroblast growth factor-23 (FGF-23) increase progressively as the kidney capacity for phosphate excretion declines, which may contribute to left ventricular hypertrophy and increased mortality in people with CKD .JOURNAL, Faul C, Amaral AP, Oskouei B, Hu MC, Sloan A, Isakova T, Gutiérrez OM, Aguillon-Prada R, Lincoln J, Hare JM, Mundel P, Morales A, Scialla J, Fischer M, Soliman EZ, Chen J, Go AS, Rosas SE, Nessel L, Townsend RR, Feldman HI, St John Sutton M, Ojo A, Gadegbeku C, Di Marco GS, Reuter S, Kentrup D, Tiemann K, Brand M, Hill JA, Moe OW, Kuro-O M, Kusek JW, Keane MG, Wolf M, 6, FGF23 induces left ventricular hypertrophy, The Journal of Clinical Investigation, 121, 11, 4393–408, November 2011, 21985788, 3204831, 10.1172/JCI46122, JOURNAL, Gutiérrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Jüppner H, Wolf M, 6, Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis, The New England Journal of Medicine, 359, 6, 584–92, August 2008, 18687639, 2890264, 10.1056/NEJMoa0706130,
• Hypocalcemia results from 1,25 dihydroxyvitamin D3 deficiency (caused by high FGF-23 and reduced kidney mass)JOURNAL, Bacchetta J, Sea JL, Chun RF, Lisse TS, Wesseling-Perry K, Gales B, Adams JS, Salusky IB, Hewison M, 6, Fibroblast growth factor 23 inhibits extrarenal synthesis of 1,25-dihydroxyvitamin D in human monocytes, Journal of Bone and Mineral Research, 28, 1, 46–55, January 2013, 22886720, 3511915, 10.1002/jbmr.1740, and resistance to the action of parathyroid hormone.JOURNAL, Bover J, Jara A, Trinidad P, Rodriguez M, Martin-Malo A, Felsenfeld AJ, The calcemic response to PTH in the rat: effect of elevated PTH levels and uremia, Kidney International, 46, 2, 310–7, August 1994, 7967341, 10.1038/ki.1994.276, free, Osteocytes are responsible for the increased production of FGF-23, which is a potent inhibitor of the enzyme 1-alpha-hydroxylase (responsible for the conversion of 25-hydroxycholecalciferol into 1,25 dihydroxyvitamin D3).BOOK, Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J, Harrison’s Principles of Internal Medicine, 2012, McGraw-Hill, New York, 978-0-07-174890-2, 18th, 3109, Later, this progresses to secondary hyperparathyroidism, kidney osteodystrophy, and vascular calcification that further impairs cardiac function. An extreme consequence is the occurrence of the rare condition named calciphylaxis.JOURNAL, Brandenburg VM, Cozzolino M, Ketteler M, Calciphylaxis: a still unmet challenge, Journal of Nephrology, 24, 2, 142–8, 2011, 21337312, 10.5301/jn.2011.6366,
• Changes in mineral and bone metabolism that may cause 1) abnormalities of calcium, phosphorus (phosphate), parathyroid hormone, or vitamin D metabolism; 2) abnormalities in bone turnover, mineralization, volume, linear growth, or strength (kidney osteodystrophy); and 3) vascular or other soft-tissue calcification. CKD-mineral and bone disorders have been associated with poor outcomes.
• Metabolic acidosis may result from decreased capacity to generate enough ammonia from the cells of the proximal tubule. Acidemia affects the function of enzymes and increases excitability of cardiac and neuronal membranes by the promotion of hyperkalemia.JOURNAL, Adrogué HJ, Madias NE, Changes in plasma potassium concentration during acute acid-base disturbances, The American Journal of Medicine, 71, 3, 456–67, September 1981, 7025622, 10.1016/0002-9343(81)90182-0,
• Anemia is common and is especially prevalent in those requiring haemodialysis. It is multifactorial in cause, but includes increased inflammation, reduction in erythropoietin, and hyperuricemia leading to bone-marrow suppression. Hypoproliferative anemia occurs due to inadequate production of erythropoietin by the kidneys.BOOK, Shaikh H, Aeddula NR, Anemia Of Chronic Renal Disease,www.ncbi.nlm.nih.gov/books/NBK539871/, StatPearls [Internet], StatPearls Publishing, January 2021, 30969693, NBK539871,
• In later stages, cachexia may develop, leading to unintentional weight loss, muscle wasting, weakness, and anorexia.JOURNAL, Mak RH, Ikizler AT, Kovesdy CP, Raj DS, Stenvinkel P, Kalantar-Zadeh K, Wasting in chronic kidney disease, Journal of Cachexia, Sarcopenia and Muscle, 2, 1, 9–25, March 2011, 21475675, 3063874, 10.1007/s13539-011-0019-5,
• Cognitive decline in patients experiencing CKD is an emerging symptom revealed in research literature.JOURNAL, Shea MK, Wang J, Barger K, Weiner DE, Booth SL, Seliger SL, Anderson AH, Deo R, Feldman HI, Go AS, He J, Ricardo AC, Tamura MK, 6, Vitamin K Status and Cognitive Function in Adults with Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort, Current Developments in Nutrition, 6, 8, nzac111, August 2022, 35957738, 9362761, 10.1093/cdn/nzac111, JOURNAL, Singh-Manoux A, Oumarou-Ibrahim A, Machado-Fragua MD, Dumurgier J, Brunner EJ, Kivimaki M, Fayosse A, Sabia S, 6, Association between kidney function and incidence of dementia: 10-year follow-up of the Whitehall II cohort study, Age and Ageing, 51, 1, afab259, January 2022, 35061870, 10.1093/ageing/afab259, 8782607, JOURNAL, O’Lone E, Connors M, Masson P, Wu S, Kelly PJ, Gillespie D, Parker D, Whiteley W, Strippoli GF, Palmer SC, Craig JC, Webster AC, 6, Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis, English, American Journal of Kidney Diseases, 67, 6, 925–935, June 2016, 26919914, 10.1053/j.ajkd.2015.12.028, JOURNAL, Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G, Massy ZA, Cognitive disorders and dementia in CKD: the neglected kidney-brain axis, en-US, Journal of the American Society of Nephrology, 24, 3, 353–363, February 2013, 23291474, 10.1681/ASN.2012050536, 5248658, free, Current research suggests that patients with CKD face a 35-40% higher likelihood of cognitive decline and or dementia. This relation is dependent on the severity of CKD in each patient; although emerging literature indicates that patients at all stages of CKD will have a higher risk of developing these cognitive issues.JOURNAL, Kurella M, Chertow GM, Luan J, Yaffe K, Cognitive impairment in chronic kidney disease, Journal of the American Geriatrics Society, 52, 11, 1863–1869, November 2004, 15507063, 10.1111/j.1532-5415.2004.52508.x, 23257233,
• Sexual dysfunction is very common in both men and women with CKD. A majority of men have a reduced sex drive, difficulty obtaining an erection, and reaching orgasm, and the problems get worse with age. Most women have trouble with sexual arousal, and painful menstruation and problems with performing and enjoying sex are common.JOURNAL, Vecchio M, Navaneethan SD, Johnson DW, Lucisano G, Graziano G, Saglimbene V, Ruospo M, Querques M, Jannini EA, Strippoli GF, 6, Interventions for treating sexual dysfunction in patients with chronic kidney disease, The Cochrane Database of Systematic Reviews, 12, CD007747, December 2010, 21154382, 10.1002/14651858.CD007747.pub2, Cochrane Kidney and Transplant Group,

Causes

The three most common causes of CKD in order of frequency as of 2015 are diabetes mellitus, hypertension, and glomerulonephritis.JOURNAL, Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal, Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 388, 10053, 1545–1602, October 2016, 27733282, 5055577, 10.1016/S0140-6736(16)31678-6, GBD 2015 Disease Injury Incidence Prevalence Collaborators, About one of five adults with hypertension and one of three adults with diabetes have CKD.If the cause is unknown, it is called idiopathic.WEB, United States Renal Data System (USRDS),www.usrds.org/, dead,www.usrds.org/," title="web.archive.org/web/20070213232827www.usrds.org/,">web.archive.org/web/20070213232827www.usrds.org/, 2007-02-13,

By anatomical location

• Vascular disease includes large-vessel disease such as bilateral kidney artery stenosis and small-vessel disease such as ischemic nephropathy, hemolytic-uremic syndrome, and vasculitis.
• Glomerular disease comprises a diverse group and is classified into:{{citation needed|date=December 2021}}
  • Primary glomerular disease such as focal segmental glomerulosclerosis and IgA nephropathy (or nephritis)
  • Secondary glomerular disease such as diabetic nephropathy and lupus nephritis
• Tubulointerstitial disease includes drug- and toxin-induced chronic tubulointerstitial nephritis, and reflux nephropathy
• Obstructive nephropathy, as exemplified by bilateral kidney stones and benign prostatic hyperplasia of the prostate gland; rarely, pinworms infecting the kidney can cause obstructive nephropathy.

Other

• Genetic congenital disease such as polycystic kidney disease or 17q12 microdeletion syndrome.
• Mesoamerican nephropathy, is “a new form of kidney disease that could be called agricultural nephropathy”.JOURNAL, Orantes CM, Herrera R, Almaguer M, Brizuela EG, Núñez L, Alvarado NP, Fuentes EJ, Bayarre HD, Amaya JC, Calero DJ, Vela XF, Zelaya SM, Granados DV, Orellana P, 6, Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities, MEDICC Review, 16, 2, 23–30, April 2014, 10.37757/MR2014.V16.N2.5, 24878646,www.medicc.org/mediccreview/index.php?issue=28&id=351&a=va, free, A high and so-far unexplained number of new cases of CKD, referred to as the Mesoamerican nephropathy, has been noted among male workers in Central America, mainly in sugarcane fields in the lowlands of El Salvador and Nicaragua. Heat stress from long hours of piece-rate work at high average temperaturesWEB, Tangri N, MesoAmerican Nephropathy: A New Entity, 29 July 2013, eAJKD, National Kidney Foundation,ajkdblog.org/2013/07/29/mesoamerican-nephropathy-a-new-entity/, JOURNAL, Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH, The epidemic of chronic kidney disease of unknown etiology in Mesoamerica: a call for interdisciplinary research and action, American Journal of Public Health, 103, 11, 1927–30, November 2013, 24028232, 3828726, 10.2105/AJPH.2013.301594, JOURNAL, Johnson RJ, Sánchez-Lozada LG, Chronic kidney disease: Mesoamerican nephropathy--new clues to the cause, Nature Reviews. Nephrology, 9, 10, 560–1, October 2013, 23999393, 10.1038/nrneph.2013.174, 20611337, JOURNAL, Roncal Jimenez CA, Ishimoto T, Lanaspa MA, Rivard CJ, Nakagawa T, Ejaz AA, Cicerchi C, Inaba S, Le M, Miyazaki M, Glaser J, Correa-Rotter R, González MA, Aragón A, Wesseling C, Sánchez-Lozada LG, Johnson RJ, 6, Fructokinase activity mediates dehydration-induced renal injury, Kidney International, 86, 2, 294–302, August 2014, 24336030, 4120672, 10.1038/ki.2013.492, of about 36 Â°C (96 Â°F) is suspected,WEB, Grovern N, 2021-10-21, Global heating ‘may lead to epidemic of kidney disease’,www.theguardian.com/global-development/2021/oct/21/global-heating-may-lead-to-epidemic-of-kidney-disease, live, 2021-10-25, The Guardian, en,web.archive.org/web/20211021061119/https://www.theguardian.com/global-development/2021/oct/21/global-heating-may-lead-to-epidemic-of-kidney-disease, 2021-10-21, as are agricultural chemicalsNEWS, Thousands of sugar cane workers die as wealthy nations stall on solutions,www.icij.org/project/island-widows/thousands-sugar-cane-workers-die-wealthy-nations-stall-solutions, November 26, 2012, International Consortium of Investigative Journalists, 12 December 2011, Chavkin S, Greene R,

Diagnosis

File:Combined hyperkalemia and hypocalcemia.png|thumb|upright=1.4|A 12-lead ECG of a person with CKD and a severe electrolyte imbalance: hyperkalemia (7.4 mmol/L) with hypocalcemia (1.6 mmol/L). The T-waves are peaked and the QT interval is prolonged.]]Diagnosis of CKD is largely based on history, examination, and urine dipstick combined with the measurement of the serum creatinine level. Differentiating CKD from acute kidney injury (AKI) is important because AKI can be reversible. One diagnostic clue that helps differentiate CKD from AKI is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks). In many people with CKD, previous kidney disease or other underlying diseases are already known. A significant number present with CKD of unknown cause.{{citation needed|date=December 2021}}

Screening

Screening those who have neither symptoms nor risk factors for CKD is not recommended.JOURNAL, Qaseem A, Hopkins RH, Sweet DE, Starkey M, Shekelle P, Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians, Annals of Internal Medicine, 159, 12, 835–47, December 2013, 24145991, 10.7326/0003-4819-159-12-201312170-00726, free, JOURNAL, Weckmann GF, Stracke S, Haase A, Spallek J, Ludwig F, Angelow A, Emmelkamp JM, Mahner M, Chenot JF, 6, Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines, BMC Nephrology, 19, 1, 258, October 2018, 30305035, 6180496, 10.1186/s12882-018-1048-5, free, Those who should be screened include: those with hypertension or history of cardiovascular disease, those with diabetes or marked obesity, those aged > 60 years, subjects with African American ancestry, those with a history of kidney disease in the past, and subjects who have relatives who had kidney disease requiring dialysis.{{citation needed|date=December 2021}}Screening should include calculation of the estimated GFR (eGFR) from the serum creatinine level, and measurement of urine albumin-to-creatinine ratio (ACR) in a first-morning urine specimen (this reflects the amount of a protein called albumin in the urine), as well as a urine dipstick screen for hematuria.BOOK, Johnson D, Daugirdas J, Handbook of Chronic Kidney Disease Management, Lippincott Williams and Wilkins, 2011-05-02, 32–43, Chapter 4: CKD Screening and Management: Overview,hdcn.com/CKDhandbook/toc.htm, 978-1-58255-893-6, The GFR is derived from the serum creatinine and is proportional to 1/creatinine, i.e. it is a reciprocal relationship; the higher the creatinine, the lower the GFR. It reflects one aspect of kidney function, how efficiently the glomeruli - the filtering units - work. The normal GFR is 90-120 ml/min. The units of creatinine vary from country to country, but since the glomeruli make up