What are the symptoms of kidney failure?

Symptoms of Kidney Failure

Kidney failure symptoms include uremic syndrome manifestations such as uremic frost, renal osteodystrophy, asterixis, coagulation defects, congestive heart failure, ammonia taste/breath, electrolyte disturbances, hypertension, and edema. 1

Definition of Kidney Failure

Kidney failure is defined as:

• GFR less than 15 mL/min per 1.73 m² (Stage 5 CKD) 1, 2
• May require kidney replacement therapy (dialysis or transplantation) 1
• Can be acute (developing within hours to days) or chronic (developing over months to years) 1

Clinical Manifestations of Kidney Failure

Uremic Syndrome

Uremic syndrome is a state of intoxication that affects multiple organ systems due to the accumulation of uremic toxins in the blood. Key manifestations include:

• Skin manifestations:

  • Uremic frost (crystallized urea on skin)
  • Pallor
  • Pruritus (itching)
  • Yellow-gray skin discoloration 1

• Neurological symptoms:

  • Asterixis (flapping tremor)
  • Confusion and altered mental status
  • Uremic encephalopathy
  • Seizures in advanced cases 1, 3

• Cardiovascular symptoms:

  • Hypertension
  • Congestive heart failure
  • Pericarditis
  • Edema (fluid retention) 1, 4, 5

• Gastrointestinal symptoms:

  • Nausea and vomiting
  • Anorexia (loss of appetite)
  • Metallic taste in mouth
  • Ammonia breath 1

• Hematological abnormalities:

  • Anemia
  • Bleeding tendency due to platelet dysfunction
  • Coagulation defects 1, 6

• Metabolic disturbances:

  • Electrolyte imbalances (hyperkalemia, hyperphosphatemia)
  • Metabolic acidosis
  • Hypocalcemia 1

• Musculoskeletal manifestations:

  • Renal osteodystrophy (bone disease)
  • Muscle cramps
  • Bone pain 1, 2

Fluid-Related Symptoms

• Volume overload
• Peripheral edema
• Pulmonary edema
• Shortness of breath
• Weight gain 4, 5

Oral Manifestations

• Xerostomia (dry mouth)
• Parotitis
• Altered taste sensation
• Poor oral hygiene
• Changes in saliva composition (increased urea, creatinine, sodium, potassium, chloride, and phosphorus) 1

Differences Between Acute and Chronic Kidney Failure Symptoms

Acute Kidney Injury (AKI)

• Sudden onset of symptoms (within hours to days)
• Often includes oliguria or anuria (reduced or absent urine output)
• May present with fluid overload, electrolyte imbalances, and metabolic acidosis
• Can be reversible with proper treatment 3

Chronic Kidney Disease (CKD) Stage 5

• Gradual development of symptoms over months to years
• Progressive worsening as kidney function declines
• May be asymptomatic in early stages
• Irreversible changes in kidney structure and function 1, 2

Warning Signs Requiring Immediate Medical Attention

• Severe shortness of breath
• Chest pain
• Confusion or decreased level of consciousness
• Seizures
• Severe hyperkalemia (potassium >6.5 mmol/L)
• Severe acidosis
• Pericardial friction rub (sign of uremic pericarditis) 3, 6

Pitfalls in Recognizing Kidney Failure

1. Early symptoms are often nonspecific and may be attributed to other conditions, leading to delayed diagnosis 1, 2

2. Symptoms may not appear until significant kidney function is lost (GFR <30 mL/min per 1.73 m²) 1

3. Elderly patients may present with atypical symptoms or attribute symptoms to aging 1

4. Diabetic patients have approximately 50% higher risk of progression to kidney failure compared to non-diabetic patients with similar GFR 2

5. Symptoms can be masked by medications or comorbid conditions 3

Understanding these symptoms is crucial for early recognition and management of kidney failure, which can significantly impact morbidity, mortality, and quality of life outcomes.