Progressive permanent loss of renal function over months to years. Because of adaptive mechanisms, symptoms of uremia do not appear until GFR is reduced to about 25 % of normal. Hypertension may occur early. Later, signs and symptoms include anorexia, nausea, vomiting, insomnia, weight loss, weakness, paresthesias, bleeding, serositis, anemia, acidosis, and hyperkalemia. Evidence for a specific cause may be present (diabetes mellitus, hypertension, urinary tract obstruction, interstitial nephritis). Indications of chronicity include long-standing azotemia, anemia, hyperphosphatemia, hypocalcaemia, shrunken kidneys, renal osteodystrophy by x-rays, or findings on renal biopsy.

Defined as heavy albuminuria (>3.5 g/day in the adult); may be accompanied by edema, hypoalbuminemia, hyperlipidemia, and varying degrees of renal insufficiency. Can be idiopathic or due to drugs, infections, neoplasms, multisystem or hereditary diseases. Complications include severe edema, thromboembolic events, infection, and protein malnutrition.

Blood Pressure > 140/90 mmHg may affect 20 % of the U.S. adult population and when inadequately controlled is an important contributor to cerebrovascular accident, MI, CHF, and renal failure. Hypertension is usually asymptomatic until cardiac, renal or neurologic symptoms appear. Most cases are idiopathic and occur between the ages of 25 and 45 years.