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Clinical presentation of renal disease 

Clinical presentation of renal disease

Clinical presentation of renal disease

Richard E Fielding

and Ken Farrington



Microscopic (non-visible) haematuria—updated recommendations regarding indications for referral to urological or nephrological services, and for long term monitoring if criteria for specialist referral are not met, or for patients who have had negative urological or nephrological investigations.

Revised guidelines for creatinine measurement following NICE guidance 2008.

Referral guidelines for microscopic haematuria updated following RA-BAUS Consensus Statement on Assessment of Haematuria.

Prevalence data for acute kidney injury updated.

Updated on 25 May 2011. The previous version of this content can be found here.
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date: 28 April 2017

Renal disease may present in many ways, including: (1) the screening of asymptomatic individuals; (2) with symptoms and signs resulting from renal dysfunction; and (3) with symptoms and signs of an underlying disease, often systemic, which has resulted in renal dysfunction.

History and clinical signs—in many cases these are nonspecific or not apparent, and detection of renal disease relies on a combination of clinical suspicion and simple investigations, including urinalysis (by dipstick for proteinuria and haematuria, with quantification of proteinuria most conveniently performed by estimation of the albumin:creatinine ratio, ACR, or protein:creatinine ratio, PCR) and estimation of renal function (by measurement of serum creatinine, expressed as estimated glomerular filtration rate, eGFR).

Asymptomatic renal disease—this is common and most often detected as chronic depression of glomerular filtration rate (known as chronic kidney disease, CKD), proteinuria, or haematuria, either as isolated features or in combination.

Symptomatic renal disease—may present in many ways, including: (1) with features of severe chronic depression of glomerular filtration rate—‘uraemia’, manifesting with some or all of anorexia, nausea, vomiting, fatigue, weakness, pruritus, breathlessness, bleeding tendency, apathy and loss of mental concentration, and muscle twitching and cramps; (2) acute kidney injury—also known as acute renal failure; (3) with urinary symptoms—frequency, polyuria, nocturia, oliguria, anuria, and macroscopic haematuria; and (4) loin pain.

Specific renal syndromes—these include: (1) nephrotic syndrome—comprising oedema, proteinuria, and hypoalbuminaemia—caused by primary or secondary glomerular disease; and (2) rapidly progressive glomerulonephritis with acute renal failure.

Other conditions—renal disease may be associated with and present in the context of many underlying conditions, including: (1) diabetes mellitus; (2) renovascular disease; (3) myeloma and other malignancies; (4) infectious diseases, either as a nonspecific manifestation of the sepsis syndrome or as a specific complication of the particular infection, e.g. haemolytic uraemic syndrome, poststreptococcal glomerulonephritis, hantavirus infection, leptospirosis, HIV nephropathy; (5) systemic inflammatory diseases, e.g. systemic vasculitides, rheumatological disorders, sarcoidosis, amyloidosis; (6) drug-induced renal disease; and (7) pregnancy.

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