Urological footprint of chronic kidney disease: A nephrologist perspective on early detection and collaborative management

Table 1 Urological manifestations across chronic kidney disease stages and their clinical outcomes

CKD stage	Urological manifestations	Impact on CKD outcomes	Clinical implications
Stage 1-2 (early CKD)	Polyuria, nocturia	Early signs of tubulointerstitial damage; often missed, delaying diagnosis	Need for early screening and symptom recognition
Stage 3-4 (moderate CKD)	LUTS (urgency, frequency, hesitancy), recurrent UTIs	UTIs accelerate nephron loss; LUTS complicate fluid balance	Routine urological evaluation; manage comorbidities like diabetes/BPH
Stage 5 (ESKD, pre-dialysis)	Bladder dysfunction (DU, BO), anuria, incontinence	Disuse atrophy, fibrosis, increased infection risk, poor dialysis outcomes	Multidisciplinary care; monitor bladder function and infection risk
Dialysis-dependent	Reduced bladder capacity, poor sensation, persistent LUTS	LUTS persist despite anuria; linked to lower QoL	Use of validated questionnaires; targeted symptom management
Post-transplant	Ureteral stenosis, VUR, persistent LUTS	Surgical complications and persistent symptoms affect graft function	Coordinated nephrology-urology follow-up

CKD: Chronic kidney disease; ESKD: End-stage kidney disease; LUTS: Lower urinary tract symptoms; DU: Detrusor underactivity; BO: Bladder oversensitivity; VUR: Vesicoureteral reflux; UTI: Urinary tract infection; QoL: Quality of life; BPH: Benign prostatic hyperplasia.