N18.4
Chronic kidney disease, stage 4 (severe)
Clinical Classification Guidelines
Medical Intelligence & Overview
Chronic kidney disease (CKD) stage 4, also known as severe CKD, represents advanced kidney damage with a significant reduction in kidney function. At this stage, the kidneys are functioning at approximately 15-29% of normal capacity, which can lead to a build-up of waste products and fluid imbalances in the body. Recognizing and understanding this stage is crucial for managing symptoms and preventing further progression to kidney failure.
Causes & Symptoms
Clinical Causes: Long-standing high blood pressure (hypertension) Diabetes mellitus, especially poorly controlled Glomerulonephritis (inflammation of the kidney's filtering units) Polycystic kidney disease Chronic urinary tract obstructions Repeated kidney infections Use of nephrotoxic medications over time Vascular diseases affecting kidney blood flow
Key Symptoms: Swelling in the legs, ankles, or feet (edema) Fatigue and weakness Shortness of breath Changes in urine output, such as foamy urine or decreased production Blood in the urine (hematuria) Persistent nausea and vomiting Difficulty concentrating Reduced appetite Muscle cramps High blood pressure that is difficult to control
Diagnostic & Treatment
Diagnosis Path: Diagnosis of stage 4 CKD typically involves a combination of medical history, physical examination, and laboratory tests. Key diagnostic measures include:
Treatment Protocols: Management of stage 4 CKD aims to slow disease progression, manage symptoms, and prepare for possible kidney replacement therapy. Treatment approaches include:
Clinical Advice & FAQs
Billing Guidance
Is N18.4 a billable ICD-10 code?
Yes, N18.4 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.
Documentation
How do I report N18.4?
Clinical documentation must specify the nature of Chronic kidney disease, stage 4 (severe) and any associated comorbidities for accurate reporting.
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