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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

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date: 02 March 2021

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 and estimation of renal function. Asymptomatic renal disease—this is common and most often detected as chronic depression of eGFR (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 (AKI); (3) with urinary symptoms—frequency, polyuria, nocturia, oliguria, anuria, and visible (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 AKI. 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; (5) systemic inflammatory diseases; (6) drug-induced renal disease; and (7) pregnancy.

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