Clinical Features of chronic Kidney Disease

In the early stages of chronic kidney disease symptoms may not be present and about 20% of patients can have chronic kidney disease for a number of years. This is important, for example, in those with undiagnosed Type 2 Diabetes who when eventually diagnosed may present with established kidney damage.

A significant number of people may have chronic kidney disease without being aware of it. Symptoms become obvious when the glomerular filtration rate (GFR) is only 20 ml/minute or less and can affect any system in the body.

• Weakness and tiredness/ fatigue. This is the most common and noticeable symptom.
• Nocturia (the need to pass urine in the night) is often an early symptom
• Itchiness of the skin which can progressively worsen
• Pale skin which is easily bruised
• Muscular twitches, cramps and pain
• Pins and needles in the hands and feet
• Nausea

As the condition worsens the symptoms progress to include:

• Oedema (swelling of the face, limbs and abdomen)
• Oliguria (greatly reduced volume of urine)
• Dyspnoea (breathlessness)
• Vomiting
• Confusion
• Seizures
• Severe lethargy
• Very itchy skin
• Breath that smells of ammonia

Associated complications of chronic Kidney Disease would be:

• Anaemia, mostly due to deficiency of erythropoietin
• Bleeding which is caused by impairment of platelet function
• Metabolic Bone Disease (known as Renal Osteodystrophy)
• Cardiovascular Disease
  • hypertension, (which may further exacerbate the renal failure)
  • accelerated atherosclerosis
  • pericarditis. 80% of those with chronic renal failure develop hypertension which must be treated
• Nervous system – neuropathy caused by the loss of myelin from nerve fibres – may improve when dialysis is established
• Gastrointestinal complications - anorexia, nausea and vomiting, and a higher incidence of peptic ulcer disease
• Skin disease – itching, which is attributed to the retention of metabolic waste products. It often improves with dialysis. Dry skin can also occur
• Muscle dysfunction - myopathy leading to muscle cramps and the “restless leg” syndrome
• Metabolic dysfunction - involving lipids, insulin and uric acid (gout). Metabolic acidosis is also associated

“Most patients with chronic kidney disease never progress to established renal failure but have significantly increased risk of death from cardiovascular disease.” (Management of Chronic Kidney Disease - C. Tomson and U.Udayaraj ScienceDirect August 2007).

Click on the link for details of:

• Investigations and Tests
• Inflammatory Kidney Disease
• Diagram of Symptoms / Signs Chronic Kidney Disease

Amended April 2008