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Second Part
Plain abdominal X-ray is particularly useful to look for radio-opaque stones ornephroca lcinosis. Intravenous pyelography is often used to diagnose renal stones. Renal ultrasound is a useful test to screen for hydronephrosis, which may not be observed in early obstruction. Renal radionuclide scan is useful to screen for renal artery stenosis when performed with captopril administration but is unreliable for GFR of less than 30 cc/min. CT scan is useful to better define renal cysts usually noted on ultrasound. Also, it is the most sensitive test for identifying renal stones. IV contrast-enhanced CT scans should be avoided in patients with renal impairment so as to avoid acute renal failure; this risk significantly increases in patients with moderate-to-severe CKD. MRI is very useful in patients who require a CT scan but who cannot receive intravenous contrast. Magnetic resonance angiography also is becoming more useful for diagnosis of renal artery stenosis, although renal arteriography remains the criterion standard.
Treatment of the patients with CKD should focus on: delaying or halting progression of CKD; treating pathologic manifestations of CKD; timely planning for chronic renal replacement therapy.
1. What leads to a progressive decline in glomerular filtration rate (GFR)?
2. What is the most common cause of death in the dialysis patients with CKD?
3. What can't be included in the findings from physical examination to the patients with CKD?
4. Who do not experience clinically evident disturbances in water or electrolyte balance?
5. How many stages are mentioned in the passage for the patients with CKD?

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