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  • Chronic kidney disease (CKD) is a heterogeneous group of disorders affecting kidney structure and function. Symptoms include: anorexia, nausea, vomiting, stomatitis, dysgeusia, nocturia, lassitude, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, water retention, undernutrition, gastrointestinal ulceration and bleeding, peripheral neuropathies, and seizures. Diagnosis is based on laboratory testing of renal function and sometimes renal biopsy. Treatment directed at the underlying condition but includes fluid and electrolyte management, erythropoietin for anemia, dialysis or transplantation. CKD may result from a number of causes including: vascular disease; primary and secondary glomerular diseases; tubulointerstitial disease; and urinary tract obstruction. Markers of kidney damage in addition to proteinuria include urine sediment abnormalities and abnormalities on imaging studies. Two major outcomes of CKD include: loss of kidney function leading to failure; and development of cardiovascular disease. High blood pressure is both a cause and a complication of CKD and is associated with a faster loss of kidney function and development of cardiovascular disease. Additional complications include: anemia; malnutrition; bone disease and disorders of calcium and phosphorus metabolism; and neuropathies. Criteria for CKD established by the National Kidney Foundation are: kidney damage for =3 months (structural or functional abnormalities) with or without decreased glomerular filtration rate manifested by either pathological abnormalities or markers of kidney damage (urine or blood abnormalities, or abnormalities in imaging tests); and glomerular filtration rate <60 mL/min/1.73m2 for =3 months, with or without kidney damage.
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