<aside> 🫘

High-yield First Aid buzzwords (memorize first):

• CKD = GFR <60 for ≥3 months
• ESRD = GFR <15 or dialysis
• Anemia = ↓ EPO
• Hyperphosphatemia → ↓ Ca²⁺ → ↑ PTH (secondary hyperparathyroidism)
• Uremia = pericarditis, platelet dysfunction

NBME test-taking strategy (1 line): If chronic kidney disease → think EPO ↓, phosphate ↑, PTH ↑, metabolic acidosis.

• If you see CKD + anemia → ↓ EPO
• If you see CKD + bone pain → secondary hyperparathyroidism
• If you see CKD + pruritus + pericarditis → uremia
• If you see hyperkalemia + acidosis → dialysis indication </aside>

Definition

CKD =

• GFR <60 mL/min/1.73 m²

  OR

• Kidney damage ≥3 months (proteinuria, structural damage)

ESRD =

• GFR <15

  OR

• Requires dialysis

• MCC of CKD: Diabetes Mellitus
• MCC of death in CKD: cardiovascular disease (34.7%)
  • malignant neoplasms are the 2nd MCC (31.8%)

"Half-and-half" nails (Lindsay nails)

• Chronic renal failure is associated with "half-and-half" nails (Lindsay nails), a sharply demarcated transverse leukonychia.  The mechanism remains unknown but is unlikely to be related to azotemia because the transition line disappears after renal transplantation but not with hemodialysis.
• Complication of ESRD: hyperkalemia

Pathophysiology Progression

Loss of nephrons → Remaining nephrons hyperfilter → Glomerulosclerosis → Progressive decline in GFR