Investigations

Blood tests include:

• urea, which increases
• calcium, which is low:
  • secondary to renal phosphate retention and acquired vitamin D resistance
  • lack of activated vitamin D leads to reduced calcium absorption from the gut
• hyperphosphataemia - due to reduced excretion
• acidosis
• uric acid - often raised - however clinical gout rarely occurs
• reduced creatinine clearance

Other important investigations include:

• renal imaging
• the gold standard is renal biopsy

A diabetic patient should be screened for diabetic retinopathy. The presence of diabetic retinopathy in a diabetic patient with chronic renal failure is suggestive of diabetic glomerulosclerosis.

An ECG will demonstrate cardiac arrhythmias caused by electrolyte imbalance.