From the Guidelines
Symptoms of Renal Impairment or Nephropathy
Symptoms of kidney damage or disease may include hematuria, proteinuria, and decreased glomerular filtration rate (GFR), often presenting with edema, hypertension, and electrolyte imbalances 1. Patients may also experience uremic symptoms such as nausea, vomiting, and pruritus, particularly in advanced stages of chronic kidney disease (CKD) 1.
- Key symptoms:
- Hematuria: presence of blood in the urine
- Proteinuria: presence of excess proteins in the urine
- Edema: swelling due to fluid retention
- Hypertension: high blood pressure
- Electrolyte imbalances: disturbances in the balance of essential minerals
- Uremic symptoms: nausea, vomiting, pruritus, etc., due to toxin buildup
- Laboratory findings may reveal:
- Elevated serum creatinine levels, typically above 1.2 mg/dL for women and 1.4 mg/dL for men
- Decreased urine output, often below 400 mL per 24 hours
- Abnormal albumin-to-creatinine ratio in urine, indicating kidney damage 1 These symptoms and findings prompt further evaluation and potential initiation of treatments to slow disease progression, such as renin-angiotensin-aldosterone system (RAAS) inhibitors, like lisinopril 10-40 mg daily 1.
From the FDA Drug Label
5.3 Impaired Renal Function Monitor renal function periodically in patients treated with lisinopril. Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system.
The symptoms of renal impairment or nephropathy are not directly stated in the provided drug labels. However, it is mentioned that changes in renal function, including acute renal failure, can be caused by drugs that inhibit the renin-angiotensin system, such as lisinopril.
- Patients at risk of developing acute renal failure on lisinopril include those with:
- Renal artery stenosis
- Chronic kidney disease
- Severe congestive heart failure
- Post-myocardial infarction
- Volume depletion It is recommended to monitor renal function periodically in patients treated with lisinopril and consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function 2.
From the Research
Symptoms of Renal Impairment or Nephropathy
The symptoms of renal impairment or nephropathy can be non-specific and may not always be present in the early stages of the disease. Some common symptoms include:
- Lethargy
- Itch
- Loss of appetite 3
- Anaemia due to reduced production of erythropoietin by the kidney; reduced red blood cell survival and iron deficiency 3
- Mineral bone disease caused by disturbed vitamin D, calcium, and phosphate metabolism 3
- Left ventricular hypertrophy, vascular calcification, anemia, and renal osteodystrophy 4
- Uremic syndrome, which can be avoided by renal replacement therapy 4
Diagnosis and Detection
Renal impairment or nephropathy can be detected incidentally via urinalysis showing proteinuria or blood test results showing an elevated creatinine level 5. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most accurate creatinine-based method for estimating glomerular filtration rate (GFR) in routine practice 5. Cystatin C level measurement can be considered if patients have factors that might make creatinine-based equations inaccurate 5.
Classification and Staging
Chronic kidney disease (CKD) is defined as a GFR less than 60 mL/min/1.73 m2 or persistent evidence of kidney damage on imaging, biopsy, or urinalysis that persists for longer than 3 months 5, 3. CKD is classified into stages based on estimated GFR, degree of proteinuria, and the cause 5. The presence of proteinuria is associated with increased risk of progression of CKD and death 3.
Risk Factors and Progression
Diabetes and hypertension are the main causes of CKD in all high-income and middle-income countries, and also in many low-income countries 3. The risk of progression to end-stage kidney disease (ESKD) is higher in patients with albuminuria or proteinuria compared to those without 6, 7. The rate of eGFR decline is generally larger among patients with type 2 diabetes, particularly in those with severely increased albuminuria 7.