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C hronic kidney disease (CKD) is a broad term used to describe any abnormality of kidney structure or function. It is often asymptomatic in the early stages and co-exists with other chronic illnesses, such as diabetes and hypertension. It is associated with an increased risk of cardiovascular disease, end-stage renal failure, anaemia and metabolic bone disease. Early detection of CKD and managing risk factors may provide an opportunity to prevent progression of associated risks. This article will discuss the diagnosis, classification, management and complications of CKD, and when to refer to secondary care. THE GP curriculum and chronic kidney disease Clinical module 3.12: Cardiovascular health states that a GP should be able to:. Demonstrate an understanding of the importance of risk factors, including chronic kidney disease, in the diagnosis and management of cardiovascular problems Clinical module 3.17: Care of people with metabolic problems states that a GP should be able to:. Recognise that patients with metabolic problems are frequently asymptomatic or have non-specific symptoms and that diagnosis is often made by screening or recognising symptom complexes and arranging appropriate investigations. Know the indications for referral to.. .(a) nephrologist for investigation of. .. diabetic renal complications Chronic kidney disease Chronic kidney disease (CKD) is a complex condition encompassing a broad heterogeneity of disease processes that often co-exist and overlap with other chronic illnesses, especially vasculopathies. The most common causes of CKD are diabetes and hypertension (Levey & Coresh, 2012). The burden of disease is significant, with current primary care data suggesting approximately 8.5% of the UK population suffer with moderate to severe CKD (stages 3 to 5) (National Institute for Health and Care Excellence (NICE), 2014). Thus, at least 500 patients

Nephrotic syndrome is characterised by proteinuria, hypoalbuminaemia and oedema. The renal function is often normal and symptoms may mimic other common pathologies presenting in the community. The underlying aetiology is more heterogenous in adults compared with children, further confounding the diagnostic process and leading to delays in recognition. It is a relatively rare presentation in primary care, but the consequences of nephrotic syndrome can be significant. Complications include hyperlipidaemia, hypercoaguability, increased risk of infection and end-stage renal failure. It is, therefore, important to diagnose, investigate and manage nephrotic syndrome appropriately.

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