Clinical Assessment of a Patient with Chronic Kidney Disease

Abstract

An ideal history and physical examination is essential in proper management of chronic kidney disease (CKD). All newly admitted patients with kidney dysfunction, all CKD patients with acute deterioration, and all regularly followed CKD patients should have a history and physical examination as their initial assessment. Initial history should concentrate on whether the condition is an acute or chronic kidney disease and whether there is any underlying causative or contributory disease or factor for CKD. History should target to assess the stage of CKD, presence of any factor for acute deterioration and any complication or comorbidity, and assessment of progression and cardiovascular status in follow-up visits. Physical examination should focus on blood pressure, volume status, and cardiovascular examination. All CKD patients should have serum creatinine measurement, estimation of the glomerular filtration rate (GFR) with an equation that uses serum creatinine, complete urinalysis, and measurement of albuminuria with albumin-creatinine ratio (ACR) as part of their initial assessment. Other markers for estimating GFR or direct measurement of GFR may be carried out in special situations. All CKD patients should have assessment of eGFR and ACR at least annually. Patients in late stages or who progress faster or who have any intercurrent illness may have frequent assessments. Other lab tests may be ordered as a part of general assessment or management of comorbidities and complications of CKD.