Chronic kidney disease--a disease domain complex.

Chronic kidney disease (CKD) is a silent disorder that is under-recognized. It is most often diagnosed by biochemical abnormalities. The combination of age, ethnicity, gender, and serum creatinine yields the best overall index of kidney function, and the estimated glomerular filtration rate (GFR) must be readily available for clinical practitioners to facilitate identification of CKD. The detection of persistent proteinuria also heralds the presence of CKD, but this sign is often ignored. A detailed case study is presented to demonstrate the evolution of CKD and its insidious progression to a multifaceted and complex disorder. Delineation of the complications of CKD permits the adaptation of a collaborative action plan between primary care physicians and nephrologists, and sample approaches are outlined.