Where Knowledge and Understanding Meet

Revision Date

Uremic Symptoms, Signs and Other Manifestations Codified

Share Button

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
CHF
Pulmonary edema
Ascites

Hypovolemia
Hyperkalemia
A-V Heart block
Ventricular
arrhythmia
Asystole

Hypokalemia
Rhabdomyolysis
(Muscle breakdown)
Ileus

Arrhythmias

Hypernatremia

Hyponatremia



Hypocalcemia
↓ vitamin D metabolism and ↓ phosphorus excretion

Other
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


Hiccups
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
and
Muscles
Neuromuscular disturbances
Neuropathy

Myopathy
Encephalopathy
Restless leg →
syndrome
Limb pain, numbness, weakness, paresthesias


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


Cardiomyopathy
Heart failure

Accelerated atherosclerosis
Angina
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)



Rales
Digestive System
(Gastrointestinal)
Peptic ulcer →

>Peritonitis

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)
Splenomegaly
Immune SystemImmune suppressionTypical symptoms of particular infections acquiredFever and other signs of infections acquired
Integumentary System
(Skin)

Uremic frost
Widespread pruritus (itching) Ecchymosis (bruises)

Crystalized urea deposits in the skin

Save

Save

Save

Save

Save

Share Button

Leave a Reply

Your email address will not be published. Required fields are marked *

11 − 7 =

© 2015 Frontier Theme
error: Content is protected !!