Individuals suffering from chronic kidney insufficiency are at risk of developing cardiovascular, skeletal, and metabolic complications, which is why their quality of life progressively declines over the course of years [1] [2] [3] [4]. One of the most prevalent signs of chronic kidney insufficiency is anemia, seen in up to 50% of cases [1] [4]. Anemia stems from the inability of the damaged kidneys to produce erythropoietin, thus promoting various cardiovascular disorders, such as left ventricular hypertrophy, hypertension, angina, and heart failure [1] [4]. In fact, drowsiness, fatigue, and an overall lack of energy are encountered in the majority of patients, along with pruritus and pain [5]. Dyslipidemia is a frequent finding and contributes to the appearance of cardiovascular diseases, which is the cause of death in up to 40% of cases [1] [6]. Renal osteodystrophy is a term denoting the pathological changes of the skeletal system that arise in the setting of chronic kidney disease and its four subtypes (osteitis fibrosa cystica, osteomalacia, adynamic bone disease, and mixed osteodystrophy) are responsible for abnormal rates of bone loss and bone growth in these patients, as well as persistent albuminuria and proteinuria [1]. Electrolyte and hormone abnormalities (particularly hyperphosphatemia and changes in the levels of parathyroid hormone, or PTH) arise at later stages and have a severe effect on morbidity [1] [6].

• Easy Bruising

  bruising and bleeding blood in your stools hiccups excessive thirst decreased interest in sex impotence insomnia sleep apnea You may also have the symptoms of any diseases that are contributing to your kidney problems. [healthline.com]

  bruising, or blood in the stool Excessive thirst Frequent hiccups Problems with sexual function Menstrual periods stop (amenorrhea) Shortness of breath Sleep problems Vomiting Exams and Tests Most people will have high blood pressure at all stages of [ufhealth.org]

  […] especially at night (nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood pressure; fatigue and weakness (from anemia or accumulation of waste products in the body); loss of appetite, nausea and vomiting; itching, easy [emedicinehealth.com]

• Anemia

  We call this interrelationship between congestive heart failure, chronic kidney insufficiency, and anemia the Cardio-Renal Anemia syndrome. [ncbi.nlm.nih.gov]

  One of the most prevalent signs of chronic kidney insufficiency is anemia, seen in up to 50% of cases. [symptoma.com]

  In addition, dietary changes and treatment to relieve specific symptoms such as anemia and high blood pressure are critical to the treatment process. [medical-dictionary.thefreedictionary.com]

  Anemia of CKD: A common problem Anemia of CKD is one of the first signs of kidney dysfunction, yet it often goes undetected because of its insidious onset. [mdedge.com]

  Often people with chronic kidney failure experience anemia. Anemia occurs when your body doesn’t produce enough red blood cells. You may need a supplement to help increase your red blood cell production. [healthline.com]

• Fatigue

  In fact, drowsiness, fatigue, and an overall lack of energy are encountered in the majority of patients, along with pruritus and pain. [symptoma.com]

  End stage renal disease causes weight loss, nausea and vomiting, fatigue, difficulty breathing and seizures. If left untreated, end stage renal disease is a fatal condition. At this stage, dialysis or a kidney transplant is usually needed. [kidneyandhypertensioncare.com]

  A Startling Diagnosis During her sophomore year of college, Kaitlyn began feeling fatigued and experiencing dizzy spells. Diagnosed with chronic kidney disease, she underwent a lifesaving transplant procedure. [hopkinsmedicine.org]

  Later-stage symptoms include: difficulty staying alert cramps and twitches numbness in your limbs weakness fatigue bad breath skin that’s darker or lighter than usual bone pain excessive thirst bleeding and bruising easily insomnia urinating much more [healthline.com]

  Increased fatigue. Toxic substances in the blood and the presence of anemia may cause feelings of exhaustion. Itching. Phosphorus, which is typically eliminated in the urine, accumulates in the blood of patients with kidney failure. [medical-dictionary.thefreedictionary.com]

• Weight Loss

  Early symptoms include: nausea and vomiting loss of appetite itching chest pain uncontrollable high blood pressure unexpected weight loss If the damage to your kidneys gets worse, you will eventually notice symptoms. [healthline.com]

  This can lead to malnutrition and weight loss. Diagnosis Kidney failure is typically diagnosed and treated by a nephrologist, a doctor that specializes in treating the kidneys. [medical-dictionary.thefreedictionary.com]

  Symptoms may include: Appetite loss General ill feeling and fatigue Headaches Itching ( pruritus) and dry skin Nausea Weight loss without trying to lose weight Symptoms that may occur when kidney function has gotten worse include: Abnormally dark or light [ufhealth.org]

  Adults can have non-specific symptoms like nausea, vomiting, weight loss, and easy fatigability. Hypertension is common in adults with chronic kidney disease. [radiopaedia.org]

• Weakness

  Symptoms of anemia include feeling tired and weak. Weak bones. CKD can change the way your body uses minerals, such as calcium and phosphorus. This can cause your bones to weaken. People who have CKD may lose their appetite. [familydoctor.org]

  Later-stage symptoms include: difficulty staying alert cramps and twitches numbness in your limbs weakness fatigue bad breath skin that’s darker or lighter than usual bone pain excessive thirst bleeding and bruising easily insomnia urinating much more [healthline.com]

  Signs and symptoms of kidney disease may include: Nausea Vomiting Loss of appetite Fatigue and weakness Sleep problems Changes in how much you urinate Decreased mental sharpness Muscle twitches and cramps Swelling of feet and ankles Persistent itching [mayoclinic.org]

  The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches. [heart.org]

  That can cause swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath. Without treatment, the damage can get worse and your kidneys may eventually stop working. That’s serious, and it can be life-threatening. [webmd.com]

• Pallor

  […] ankles Frequent urination or, in children 5 years or older, prolonged bedwetting Stunted or poor growth, as compared to similar age group peers Loss of appetite and chronic nausea Fatigue Frequent severe headaches from high blood pressure Anemia and pallor [healthychildren.org]

  Anemia Fatigue, reduced exercise capacity, and pallor Erythropoietin (EPO), the major erythropoiesis stimulator, is released from the kidneys; with renal failure, there is loss of EPO release. [pathophys.org]

• Nausea

  Early symptoms include: nausea and vomiting loss of appetite itching chest pain uncontrollable high blood pressure unexpected weight loss If the damage to your kidneys gets worse, you will eventually notice symptoms. [healthline.com]

  Nausea and Vomiting Uremia can also cause nausea and vomiting. Shortness of Breath Extra fluid in the body can build up in the lungs. This build up, combined with anemia, can result in shortness of breath. [hopkinsmedicine.org]

  Nausea, loss of appetite, and vomiting. Urea in the gastric juices may cause upset stomach. This can lead to malnutrition and weight loss. [medical-dictionary.thefreedictionary.com]

  The symptoms of hypercalcemia include: Feeling tired Difficulty thinking clearly Loss of appetite Nausea Vomiting Constipation Increased thirst Increased urination Weight loss Other side effects of Vitamin D include: Diarrhea Nausea Swelling Allergic [emedicinehealth.com]

  Diet may also help alleviate symptoms of nausea. Salt intake must be carefully regulated to control hypertension. Potassium and phosphorus consumption, over time, may also need to be restricted. [medicalnewstoday.com]

• Vomiting

  Nausea and Vomiting Uremia can also cause nausea and vomiting. Shortness of Breath Extra fluid in the body can build up in the lungs. This build up, combined with anemia, can result in shortness of breath. [hopkinsmedicine.org]

  Early symptoms include: nausea and vomiting loss of appetite itching chest pain uncontrollable high blood pressure unexpected weight loss If the damage to your kidneys gets worse, you will eventually notice symptoms. [healthline.com]

  Nausea, loss of appetite, and vomiting. Urea in the gastric juices may cause upset stomach. This can lead to malnutrition and weight loss. [medical-dictionary.thefreedictionary.com]

  You may notice one or more of the following symptoms if your kidneys are beginning to fail: Itching Muscle cramps Nausea and vomiting Not feeling hungry Swelling in your feet and ankles Too much urine (pee) or not enough urine Trouble catching your breath [kidneyfund.org]

  Adults can have non-specific symptoms like nausea, vomiting, weight loss, and easy fatigability. Hypertension is common in adults with chronic kidney disease. [radiopaedia.org]

• Loss of Appetite

  Early symptoms include: nausea and vomiting loss of appetite itching chest pain uncontrollable high blood pressure unexpected weight loss If the damage to your kidneys gets worse, you will eventually notice symptoms. [healthline.com]

  Nausea, loss of appetite, and vomiting. Urea in the gastric juices may cause upset stomach. This can lead to malnutrition and weight loss. [medical-dictionary.thefreedictionary.com]

  Loss of appetite. Swelling of hands and feet. A feeling of itchiness. Numbness. Feeling of nausea or vomiting. Muscle cramps. Darkness of skin. Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

  The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches. [heart.org]

• Hiccup

  […] include: difficulty staying alert cramps and twitches numbness in your limbs weakness fatigue bad breath skin that’s darker or lighter than usual bone pain excessive thirst bleeding and bruising easily insomnia urinating much more or less than usual hiccups [healthline.com]

  Other signs and symptoms include: Unintentional weight loss or weight gain Headache, trouble concentrating Pruritus, dry itchy skin, uremic frost Frequent hiccups, poor appetite, excessive thirst Nighttime muscle cramps, swollen ankles Oliguria, or increased [library.ahima.org]

  […] worse include: Abnormally dark or light skin Bone pain Drowsiness or problems concentrating or thinking Numbness or swelling in the hands and feet Muscle twitching or cramps Breath odor Easy bruising, or blood in the stool Excessive thirst Frequent hiccups [ufhealth.org]

• Constipation

  Supplements and medication Your treatment may involve: iron and vitamin supplements to manage anemia calcium and vitamin D supplements erythropoietin injections to stimulate the production of red blood cells phosphate binders stool softeners for constipation [healthline.com]

  All phosphate binders may cause constipation, nausea, vomiting, bowel obstruction, and fecal impaction. Phosphate binders may interfere with the absorption of other medications if these are taken together. [emedicinehealth.com]

• Asterixis

  Neuromuscular abnormalities with asterixis and muscle twitching are common, as are muscle cramps. The restless legs syndrome is a manifestation of sensory peripheral neuropathy. Motor neuropathy is a late phenomenon in uremia. [meddean.luc.edu]

• Diastolic Hypertension

  […] period are: Above 4 mg per deciliter OR At a clearance level of 20 ml or lower per minute AND You experience at least one of the following complications: Renal osteodystropy Motor or sensory nephropathy Chronic fluid overload syndrome, accompanied by diastolic [disability-benefits-help.org]

• Metallic Taste

  taste in mouth – detectable abdominal mass 12. [slideshare.net]

  Metallic Taste in Mouth/Ammonia Breath When waste builds up in the blood it is called uremia. This can make food taste different and cause bad breath. [hopkinsmedicine.org]

  Common signs and symptoms of CKD include difficulty urinating ( dysuria ), dizziness, foamy urine, frequent urination at night ( nocturia ), metallic taste (dysgeusia), swelling of the feet, ankles, feet, hands, or face ( edema ), and others. [verywell.com]

  Metallic taste in the mouth. Severe kidney failure can cause seizures, coma, and death. Reviewed on 9/27/2019 References Jameson, JL, et al. Harrison's Principles of Internal Medicine, 20th ed. (Vol.1 & Vol.2). McGraw-Hill Education 2018. [emedicinehealth.com]

  Have a metallic taste in your mouth. Have severe itching. What Happens At first with chronic kidney disease, your kidneys are still able to regulate the balance of fluids, salts, and waste products in your body. [uwhealth.org]

• Dysgeusia

  Common signs and symptoms of CKD include difficulty urinating ( dysuria ), dizziness, foamy urine, frequent urination at night ( nocturia ), metallic taste (dysgeusia), swelling of the feet, ankles, feet, hands, or face ( edema ), and others. [verywell.com]

  Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia, nocturia, lassitude, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, water retention, undernutrition, peripheral neuropathies [merckmanuals.com]

• Muscle Cramp

  Muscle cramps. Darkness of skin. Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

  Patients with CKD may not notice any symptoms during the early stages of this condition, although those in more advanced stages may experience: Fatigue Difficulty concentrating Lack of appetite Muscle cramping Dry, itchy skin Frequent urination Once CKD [kidneyandhypertensioncare.com]

  Muscle cramps. Fluid retention which causes swollen feet and ankles. Puffiness around the eyes. A need to pass urine more often than usual. Being pale due to anaemia. Feeling sick. [patient.info]

• Muscle Twitch

  twitching and cramps easy bruising and bleeding blood in your stools hiccups excessive thirst decreased interest in sex impotence insomnia sleep apnea You may also have the symptoms of any diseases that are contributing to your kidney problems. [healthline.com]

  Signs and symptoms of kidney disease may include: Nausea Vomiting Loss of appetite Fatigue and weakness Sleep problems Changes in how much you urinate Decreased mental sharpness Muscle twitches and cramps Swelling of feet and ankles Persistent itching [mayoclinic.org]

  twitching or cramps Breath odor Easy bruising, or blood in the stool Excessive thirst Frequent hiccups Problems with sexual function Menstrual periods stop (amenorrhea) Shortness of breath Sleep problems Vomiting Exams and Tests Most people will have [ufhealth.org]

• Bone Pain

  Later-stage symptoms include: difficulty staying alert cramps and twitches numbness in your limbs weakness fatigue bad breath skin that’s darker or lighter than usual bone pain excessive thirst bleeding and bruising easily insomnia urinating much more [healthline.com]

  pain – metallic taste in mouth – detectable abdominal mass 12. [slideshare.net]

  pain Drowsiness or problems concentrating or thinking Numbness or swelling in the hands and feet Muscle twitching or cramps Breath odor Easy bruising, or blood in the stool Excessive thirst Frequent hiccups Problems with sexual function Menstrual periods [ufhealth.org]

• Restless Legs Syndrome

  leg syndrome brittle hair and nails itching weight loss a loss of muscle mass muscle twitching and cramps easy bruising and bleeding blood in your stools hiccups excessive thirst decreased interest in sex impotence insomnia sleep apnea You may also have [healthline.com]

  Walking and strength training make bones stronger and stimulate muscles and nerves that can help ease "restless leg syndrome" and other nervous system problems sometimes associated with kidney disease. [kidshealth.org]

  The restless legs syndrome is a manifestation of sensory peripheral neuropathy. Motor neuropathy is a late phenomenon in uremia. [meddean.luc.edu]

  legs syndrome, and seizures (usually the result of hypertensive or metabolic encephalopathy). [merckmanuals.com]

• Muscle Weakness

  Severe muscle weakness. To check your heart rate, see the instructions for taking a pulse. [uwhealth.org]

• Pruritus

  In fact, drowsiness, fatigue, and an overall lack of energy are encountered in the majority of patients, along with pruritus and pain. [symptoma.com]

  Pruritus Common, Bothersome in Non-Dialysis CKD In a study of patients with non-dialysis CKD, pruritus was associated with poor health-related quality-of-life. [renalandurologynews.com]

  They often complain of pruritus. Internal membranes are also affected – leading to pericarditis, peritonitis and pleurisy. Uremia can also lead to hemolysis with anemia. [lecturio.com]

  Pruritus may respond to dietary phosphate restriction and phosphate binders if serum phosphate is elevated. Severe protein restriction in renal disease is controversial. [merckmanuals.com]

• Purpura

  Inflammatory injury: Common examples include post-streptococcal glomerulonephritis (GN), membranoproliferative GN, Henoch-Schönlein purpura (HSP), systemic lupus erythematosus (SLE), some forms of rapidly progressive glomerulonephritis (RPGN), IgA nephropathy [pathophys.org]

  Clinically, an increased bleeding tendency in patients with renal failure may present as gastrointestinal bleeding, bleeding from cannulation sites, retinal haemorrhage, subdural haematoma, epistaxis, haematuria, ecchymosis, purpura, bleeding from the [academic.oup.com]

  Epistaxis, menorrhagia, bruising, and purpura, as well as gut bleeding, may all occur. Uremic patients should be regarded as immunocompromised, and infection is an important cause of death in CRF and dialysis patients. [meddean.luc.edu]

• Petechiae

  […] gastrointestinal bleeding, bleeding from cannulation sites, retinal haemorrhage, subdural haematoma, epistaxis, haematuria, ecchymosis, purpura, bleeding from the gums, gingival bleeding, genital bleeding, haemoptysis, telangiectasia, haemarthrosis and petechiae [academic.oup.com]

• Epistaxis

  Clinically, an increased bleeding tendency in patients with renal failure may present as gastrointestinal bleeding, bleeding from cannulation sites, retinal haemorrhage, subdural haematoma, epistaxis, haematuria, ecchymosis, purpura, bleeding from the [academic.oup.com]

  Epistaxis, menorrhagia, bruising, and purpura, as well as gut bleeding, may all occur. Uremic patients should be regarded as immunocompromised, and infection is an important cause of death in CRF and dialysis patients. [meddean.luc.edu]

• Headache

  Headaches. High blood pressure may trigger headaches. Hypertension, or high blood pressure. The retention of fluids and wastes causes blood volume to increase, which in turn, causes blood pressure to rise. Increased fatigue. [medical-dictionary.thefreedictionary.com]

  The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches. [heart.org]

  Swelling and/or puffiness around the eyes, feet, and ankles Frequent urination or, in children 5 years or older, prolonged bedwetting Stunted or poor growth, as compared to similar age group peers Loss of appetite and chronic nausea Fatigue Frequent severe headaches [healthychildren.org]

  Symptoms of Chronic Kidney Disease Clinical Presentation of Chronic Kidney Disease Chronic renal failure often begins with generalized symptoms such as tiredness, loss of appetite and headaches. [lecturio.com]

  […] or more than 5 pounds in 7 days Little or no urine output Trouble breathing Muscle aches Fever of 100.4 F (38 C) or higher, or as advised by your healthcare provider Blood in your urine or stool Bloody discharge from your nose, mouth, or ears Severe headache [fairview.org]

• Seizure

  […] periods shortness of breath Chronic kidney disease can also lead to serious complications, including: high blood pressure fluid buildup in your lungs or other areas vitamin D deficiency, which can affect your bone health nerve damage that can lead to seizures [healthline.com]

  […] pounds in 7 days Little or no urine output Trouble breathing Muscle aches Fever of 100.4 F (38 C) or higher, or as advised by your healthcare provider Blood in your urine or stool Bloody discharge from your nose, mouth, or ears Severe headache or a seizure [fairview.org]

  End stage renal disease causes weight loss, nausea and vomiting, fatigue, difficulty breathing and seizures. If left untreated, end stage renal disease is a fatal condition. At this stage, dialysis or a kidney transplant is usually needed. [kidneyandhypertensioncare.com]

  […] common symptom) thirst bad taste in the mouth or bad breath weight loss generalized, persistent itchy skin muscle twitching or cramping a yellowish-brown tint to the skin As the kidney failure gets worse and the toxins continue to build up in the body, seizures [medbroadcast.com]

  (cardiovascular) disease Weak bones and an increased risk of bone fractures Anemia Decreased sex drive, erectile dysfunction or reduced fertility Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures [mayoclinic.org]

• Confusion

  Many of the early signs of kidney failure can be confused with other illnesses and conditions. This makes diagnosis difficult. [healthline.com]

  Before then, conflicting classifications had created a state of confusion as to how many Americans were afflicted with this progressive, life-threatening condition. [lifeextension.com]

  CKD is a case in point, confusion being generated by using the terms CKD Stage 1 or 2 or CKD categories G1A1 or G2A1 to refer to individuals who do not have CKD or have no evidence of CKD. [academic.oup.com]

  The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches. [heart.org]

  It can cause vomiting, weakness, confusion, and coma. Kidney failure is treated with dialysis. A special machine filters your blood to remove the waste build-up. Dialysis may be done in a clinic or hospital setting. [familydoctor.org]

• Insomnia

  Later-stage symptoms include: difficulty staying alert cramps and twitches numbness in your limbs weakness fatigue bad breath skin that’s darker or lighter than usual bone pain excessive thirst bleeding and bruising easily insomnia urinating much more [healthline.com]

  […] and symptoms of chronic kidney disease include: anemia blood in urine dark urine decreased mental alertness decreased urine output edema – swollen feet, hands, and ankles (face if edema is severe) fatigue (tiredness) hypertension (high blood pressure) insomnia [medicalnewstoday.com]

  Clinical Outcomes Management More Research Summaries Clinical Edge Acute Illness and Cannabis Use in Adults Pregnancy History and Risk of Miscarriage Firearms Mortality Among US Schoolchildren Rapid Point of Care Test for Influenza More FDA/CDC May 8, 2019 Insomnia [jcomjournal.com]

• Hyperreflexia

  With more severe renal disease (eg, estimated glomerular filtration rate [eGFR] 15 mL/min/1.73 m 2 ), neuromuscular symptoms may be present, including coarse muscular twitches, peripheral sensory and motor neuropathies, muscle cramps, hyperreflexia, restless [merckmanuals.com]

  With more severe renal disease (eg, estimated glomerular filtration rate [eGFR] 15 mL/min/1.73 m2), neuromuscular symptoms may be present, including coarse muscular twitches, peripheral sensory and motor neuropathies, muscle cramps, hyperreflexia, restless [msdmanuals.com]

• Nocturia

  Nocturia is often noted, principally due to failure to concentrate the urine. Lassitude, fatigue, anorexia, and decreased mental acuity often are the earliest manifestations of uremia. [merckmanuals.com]

  Common signs and symptoms of CKD include difficulty urinating ( dysuria ), dizziness, foamy urine, frequent urination at night ( nocturia ), metallic taste (dysgeusia), swelling of the feet, ankles, feet, hands, or face ( edema ), and others. [verywell.com]

  […] associated with an increased risk of death in general, particularly from cardiovascular disease.[11][14] Signs and symptoms[edit] The onset of symptoms is 5 to 10 years after the disease begins.[1] A usual first symptom is frequent urination at night: nocturia [en.wikipedia.org]

  A diagnosis of CRF is supported by a history of nephrotic or nephritic syndrome long-standing nocturia renal osteodystrophy renal anemia bilaterally small kidneys increased echogenicity on renal ultrasonography Acute-on-chronic renal failure is a common [meddean.luc.edu]

• Uremic Frost

  frost drowsiness mental cloudiness numbness in your hands and feet restless leg syndrome brittle hair and nails itching weight loss a loss of muscle mass muscle twitching and cramps easy bruising and bleeding blood in your stools hiccups excessive thirst [healthline.com]

  Other signs and symptoms include: Unintentional weight loss or weight gain Headache, trouble concentrating Pruritus, dry itchy skin, uremic frost Frequent hiccups, poor appetite, excessive thirst Nighttime muscle cramps, swollen ankles Oliguria, or increased [library.ahima.org]

  Image : “Uremic frost on forehead and scalp of young Afro-Caribbean male” by Fythrion. [lecturio.com]

  Occasionally, urea from sweat crystallizes on the skin (uremic frost). Pruritus may be especially uncomfortable. Undernutrition leading to generalized tissue wasting is a prominent feature of chronic uremia. [merckmanuals.com]

• Polyuria

  • Tubular Dysfunction- As the main function of tubules is reabsorption tubular failure results in the voiding of large volumes of dilute urine (polyuria) of low specific gravity, along with electrolytes and nutrients. 4. [slideshare.net]

  Further early indicators are polyuria, newly emerging or worsening hypertension or peripheral edemas. Depending on the etiology, there can also be flank pains or fever. [lecturio.com]

  Thus, despite moderate or severe reductions in GFR, tubulointerstitial renal diseases may manifest first as polyuria and volume depletion, with inability to concentrate the urine. [emedicine.medscape.com]

• Anuria

  In the final stages, it leads to oliguria or anuria, dyspnea, vomiting, uremic encephalopathy with a severe reduction in vigilance, as well as the patient being more susceptible to bleeding. [lecturio.com]

The diagnosis of chronic kidney disease may not be easy to attain early on, which is why a thorough laboratory assessment is necessary. Some definitions interpret chronic kidney insufficiency as kidney damage in the presence of reduced albumin levels due to reduced kidney function (estimated by calculating the glomerular filtration rate, or GFR, based on creatinine levels) that persists for at least three months [1] [3]. For this reason, a complete biochemical workup consisting of serum electrolytes, urea, albumin, and most importantly creatinine, together with urinalysis to evaluate protein loss, is crucial to make the diagnosis [1]. Hyperphosphatemia and hyperparathyroidism are common findings, whereas a complete blood count (CBC) reveals anemia with normochromic and normocytic characteristics, thus excluding causes such as iron or vitamin B12 deficiency [1]. The key step of the workup is to determine the GFR and patients are classified based on the results [1] [3]:

• Stage 1 - GFR is ≥ 90 mL/min/1.73 m2 with loss of albumin through urine
• Stage 2 - GFR values between 60-89 mL/min/1.73 m2
• Stage 3 - GFR values between 30-59 mL/min/1.73 m2
• Stage 4 - GFR values between 15-29 mL/min/1.73 m2
• Stage 5 (also known as end-stage renal disease) - GFR is < 15 mL/min/1.73 m2

To make an exact value of the GFR, a 24-hour urine collection of creatinine is used over serum values [1].

• Pericardial Effusion

  Clinical findings, internal Hypertension, heart failure, pulmonary oedema, pleural effusions, pericardial effusion, GI bleeding due to peptic ulceration, gastritis/oesophagitis/colitis, acute pancreatitis. [medical-dictionary.thefreedictionary.com]

• Hypertriglyceridemia

  This is not only to help guide initiation of statin treatment in CKD patients under the age of 50 years, but also to provide information on secondary causes of dyslipidemia such as nephrotic syndrome and to identify hypertriglyceridemia, a common lipid [acc.org]

  Dietary modification may be helpful for hypertriglyceridemia. Statins are effective for hypercholesterolemia. [merckmanuals.com]

• Abnormal Renal Function

  Neither of these studies addressed whether the ARF (or AKI) occurred against a background of normal or abnormal renal function. [cjasn.asnjournals.org]

• Uric Acid Increased

  Obermayr RP, Temml C, Gutjahr G, Knechtelsdorfer M, Oberbauer R, Klauser-Braun R: Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol 2008;19:2407-2413. [karger.com]

• Hyponatremia

  Hypocalcemia (see chapter) Hyponatremia (see chapter) Uremia: The three most severe forms of uremia are encephalopathy, bleeding diathesis, and pericarditis. [clinicaladvisor.com]

• Creatinine Increased

  Creatinine test As kidney function declines, your creatinine increases. This protein is also related to muscle mass. Parathyroid hormone (PTH) test The kidney and the parathyroid glands interact through the regulation of calcium and phosphorus. [healthline.com]

1. Thomas R, Kanso A, Sedor JR. Chronic Kidney Disease and Its Complications. Prim Care. 2008;35(2):329-vii.
2. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2047.
3. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO) Kidney Int. 2005;67:2089–2100.
4. McClellan W, Aronoff SL, Bolton WK, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin. 2004;20:1501–1510.
5. Almutary H, Bonner A, Douglas C. Symptom burden in chronic kidney disease: a review of recent literature. J Ren Care. 2013;39(3):140-150.
6. Parmar MS. Chronic renal disease. BMJ : British Medical Journal. 2002;325(7355):85-90.