From the Guidelines
Kidney disease in nephrology is often asymptomatic in its initial stages, but common symptoms include decreased urine output, fluid retention, and electrolyte imbalances.
Symptoms of Kidney Disease
The symptoms of kidney disease can vary depending on the type and stage of the disease.
- Acute Kidney Injury (AKI): characterized by an abrupt decrease in kidney function, with symptoms such as decreased urine output, fluid retention, and electrolyte imbalances 1.
- Chronic Kidney Disease (CKD): often asymptomatic in its initial stages, but may progress to symptoms such as fatigue, weakness, and shortness of breath 1.
- Acute Kidney Disease (AKD): includes disorders characterized by markers of kidney damage, such as hematuria, pyuria, or urinary tract obstruction, with symptoms similar to AKI 1.
Diagnosis and Evaluation
Diagnosis of kidney disease typically involves a thorough history, physical examination, and laboratory analysis of blood and urine, including measurement of serum creatinine, blood urea nitrogen, and urine protein-to-creatinine ratio 1.
- CKD diagnosis: based on the presence of albuminuria and/or reduced estimated glomerular filtration rate (eGFR) for 3 or more months, with or without signs or symptoms of other primary causes of kidney damage 1.
- AKI diagnosis: based on an increase in serum creatinine by 0.3 mg/dL within 48 hours or an increase in serum creatinine to 1.5 times baseline within the prior 7 days, or urine volume less than 0.5 mL/kg/h for 6 hours 1.
From the Research
Symptoms of Kidney Disease
The symptoms of kidney disease can vary depending on the stage and severity of the disease. According to 2, chronic kidney disease (CKD) can cause a range of uremic symptoms, including:
- CKD-associated pruritus
- Emotional/psychological distress
- These symptoms often occur in clusters, and treating one symptom may alleviate other symptoms in that cluster.
Prevalence of Symptoms
Studies have shown that patients with advanced CKD managed without dialysis experience a high burden of symptoms. For example, 3 found that the most prevalent symptoms reported by patients with CKD stage 4-5 were:
- Weakness (75%)
- Poor mobility (75%)
- Poor appetite (58%)
- Pain (56%)
- Pruritus (56%)
- Dyspnoea (49%)
Symptom Burden and Quality of Life
The symptom burden of CKD can have a significant impact on quality of life. According to 4, patients with moderate to severe CKD experience a substantial burden of symptoms, including:
- Soreness in muscles
- Feeling washed out or drained
- Cramps
- Shortness of breath
- Dry skin
- Altered sex life
- Numbness in hands or feet The study found that a high overall symptom burden was associated with poorer health-related quality of life.
Symptom Prevalence in Stage 5 CKD
A cross-sectional survey of patients with stage 5 CKD managed conservatively found that symptoms reported by more than one third of patients included:
- Lack of energy (76%)
- Pruritus (74%)
- Drowsiness (65%)
- Dyspnea (61%)
- Edema (58%)
- Pain (53%)
- Dry mouth (50%)
- Muscle cramps (50%)
- Restless legs (48%)
- Lack of appetite (47%)
- Poor concentration (44%)
- Dry skin (42%)
- Sleep disturbance (41%)
- Constipation (35%) 5.
Qualitative Description of Symptom Experience
A qualitative descriptive study found that patients with non-dialysis-dependent CKD reported a wide range of symptoms, including:
- Physical symptoms such as altered taste perception, sleep disturbance, and fatigue
- Psychological symptoms such as forgetfulness, poor concentration, and a sensation of gradually slowing down 6. The study highlighted the need for clinicians to incorporate symptom assessment into routine clinical consultations, as patients may not routinely report their symptoms.