Nephrology & Renal Medicine

Chronic Kidney Disease, Stage G5/A3 (End-Stage Renal Disease)

ICD-10 Code

N18.5

End-stage renal impairment defined by an estimated glomerular filtration rate (eGFR) <15 mL/min/1.73m² with severe albuminuria (UACR >300 mg/g). Associated with systemic uremic symptoms, metabolic bone disease, refractory anemia, and cardiovascular calcification. Requires transition planning for renal replacement therapy.

Clinical Presentation & Protocol

Patient Usually Complains Of

Patient presents for follow-up of CKD G5/A3. Reports symptoms of uremia including fatigue, anorexia, nausea, and pruritus. Denies chest pain or shortness of breath. Current eGFR <15 mL/min/1.73m² with persistent severe albuminuria. Discussed transition to renal replacement therapy (RRT) options including hemodialysis, peritoneal dialysis, or preemptive transplant.

Clinical Examination Findings

Patient appears chronically ill, pale, and fatigued. Skin: xerosis, excoriations noted on extremities. HEENT: conjunctival pallor present. Edema: 2+ pitting edema noted in bilateral lower extremities. Weight: [X] kg, stable/increased since last visit.

Treatment Protocol

Initiate/adjust renal replacement therapy planning. Optimize anemia management with ESA and iron supplementation as indicated. Phosphorus binders, vitamin D analogs, and calcium-sensing receptor agonists prescribed for CKD-MBD. Strict monitoring of potassium and phosphate intake. Review medication list for nephrotoxic agents and dose adjustments.

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