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Uremic Symptoms, Signs and Other Manifestations Codified

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Uremic symptoms and signs are the evidence of end-stage kidney disease to victims of it and observers.  An organized and uremic symptomssystematic approach is the best way to learn about them and recognize them.  This holds true for both patients and clinicians.  Such an approach involves knowing the kidney functions it can affect; the organ systems that can be involved; and the secondary diseases it can cause.  The tables below are useful tools to this end.

Direct Signs and Symptoms of Chronic Renal Failure

Direct signs and symptoms of chronic renal failure when it is end-stage are those due to the loss of nephrons.  As such, they reflect a decline in or loss of one or more of the specific functions of the kidney.  The following list contains some of the most common ones, but is not all-inclusive.

Kidney Function DisturbanceResulting DisorderSymptomsPhysical Signs
Fluid & electrolyte regulationHypervolemia
Pulmonary edema

A-V Heart block

(Muscle breakdown)




↓ vitamin D metabolism and ↓ phosphorus excretion

Shortness of breath, cough

Distended abdomen

Lightheadedness, syncope

Muscle fatigue, weakness, paralysis, tingling, numbness, nausea, palpitations, syncope

Muscle weakness, muscle cramping
Muscle pain
Abdominal pain, bloating vomiting, constipation or no bowel movement

Palpitations, lightheadedness, syncope

Increased thirst, dry mouth, muscle cramps, weakness, or twitching, headaches, lethargy, confusion, irritability

Fatigue, muscle spasms, nausea, vomiting, headache, confusion, lethargy, other changes in mental status and personality

Muscle aching, paresthesias, muscle twitching, muscle spasm

Elevated blood pressure, peripheral edema, rales, tachycardia, tachypnea
Fluid wave
Hypotension, tachycardia

Irregular heartbeat, bradycardia

Cessation of heartbeat

Hypoventilation, hypotension, tetany

Distended abdomen, decreased or absent bowel sounds

Tachycardia, irregular heartbeats

Increased deep tendon reflexes, coma, seizures

Increased deep tendon reflexes, seizures, coma, death

Tetany, increased deep tendon reflexes, seizures

Blood pressure regulationHypertensionHeadachesElevated blood pressure
Acid/base balance maintenanceRenal tubular acidosisFatigue, decreased alertness, confusion, muscle weakness, renal stone pain, muscle cramps, bone painTachypnea, stunted growth in children, tachycardia, irregular heartbeats
Red blood cell productionAnemia

Fatigue, poor stamina, shortness of breath, weakness, lightheadedness, pallor (skin paleness)Tachycardia, tachypnea

Systemic Uremia Signs and Symptoms

Systemic uremia signs and symptoms are those resulting from the effects of end-stage kidney failure on systems and organs of the body.  They are often those of secondary diseases the condition causes.  The presumption is that these manifestations are the result of the buildup of toxic metabolites that the kidneys don’t excrete.  Although that might be the case with some, it is not so across the board. 

The table below contains some of the more common manifestations. There is an overlap of many of the signs and symptoms with the varied pathology that produces them.  The groupings to the right of the arrows pointing to the right are symptoms and signs of the respective disorders to the left.  They relate whether or not uremia is the cause. 

Body System DisturbanceSystemic DisorderSymptomsSigns
Endocrine-MetabolicSecondary hyperparathyroidism

Protein malnutrition

Reduced Sex organ and reproductive hormone function
Nausea, vomiting, anorexia, abdominal pain, constipation, muscle weakness, bone pain, confusion, depression

Poor stamina

Infertility, decreased libido, impotence, cessation of menstruation
Weight loss, stupor, coma, other changes in mental status and personality

Weight loss, loss of muscle mass
Nervous System
Neuromuscular disturbances

Restless leg →
Limb pain, numbness, weakness, paresthesias

Muscle pain
Fatigue, malaise
Urge to move limbs while resting
Coma, seizures
Respiratory (Pulmonary)

Heart failure

Accelerated atherosclerosis
Heart Attack
Peripheral Arterial Disease

Uremic lung (rare in this era of dialysis)
Sharp stabbing chest pain partly relieved by sitting and leaning forward and worsened by deep breathing, fatigue

Fatigue, poor stamina, dyspnea

Chest pain, other heart attack symptoms, lightheadedness, syncope, claudication

Cough, dyspnea, hemoptysis
Pericardial friction rub

Distended neck veins with head raised 45°, gallop(s), rales, tachypnea, peripheral edema, hypotension

Tachycardia, irregular heartbeats, diaphoresis, other heart attack signs, weak pulses (particularly in the feet)

Digestive System
Peptic ulcer →


Anorexia, nausea and vomiting,
Gastrointestinal bleeding
Diffuse abdominal pain
Urine-like odor on the breath

Rebound tenderness, reduced or absent bowel sounds
Hematologic SystemAnemia from
↓ RBC production or hemolysis
Impaired platelet → function
Typical symptoms of anemia (see above chart)

Bleeding tendency, easy bruising
Typical signs of anemia (see above chart)
Immune SystemImmune suppressionTypical symptoms of particular infections acquiredFever and other signs of infections acquired
Integumentary System

Uremic frost
Widespread pruritus (itching) Ecchymosis (bruises)

Crystalized urea deposits in the skin






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