A myriad of disorders may cause the inability of the kidneys to perform their respective function, and the term renal impairment encompasses two major disorders - acute and chronic kidney failure:

• Acute renal failure (ARF) can stem from diseases of pre-renal (severe bleeding, hypovolemia, extensive burns, renal hypoperfusion, heart failure, liver cirrhosis, etc.), intrinsic renal (the glomeruli, the tubules, the interstitium, and/or the renal blood vessels), and post-renal systems (obstructive uropathy arising from blood clots, tumors, or congenital defects) [1] [2]. Patients in the intensive care unit who are critically ill are most susceptible to ARF [1] [3], who present with symptoms of shock due to the severe effects of hyperkalemia, metabolic acidosis and diminished glomerular filtration rate (GFR) [2].
• Chronic renal failure - Contrary to ARF, a slowly progressing course of symptoms is seen in chronic renal impairment. At first, patients may be completely asymptomatic, but signs such as alterations in urinary habits (nocturia), generalized weakness, and fatigue eventually ensue [4] [5]. As chronic renal failure is an irreversible and progressive process, further deterioration of kidney function leads to neuromuscular symptoms (hyperreflexia, cramping, neuropathies, or even convulsions), weight loss, nausea, pruritus, and anorexia [4] [5]. The last stage of chronic renal failure, termed end-stage renal disease (ESRD), can include all of the mentioned symptoms, as well as muscle wasting, depression, anxiety, constipation, sleep disturbances, restless legs, and dyspnea [2] [4] [6].

• Anemia

  A blood test showed thrombocytopenia, anemia, and elevated C-reactive protein, alkaline phosphatase, and creatinine levels. [ncbi.nlm.nih.gov]

  Anemia is characteristic of moderate to advanced CKD (≥ stage 3). The anemia of CKD is normochromic-normocytic, with an Hct of 20 to 30% (35 to 40% in patients with polycystic kidney disease ). [merckmanuals.com]

  Anemia is common with CKD. The two most common causes of anemia with kidney disease are iron deficiency and the lack of erythropoietin. [emedicinehealth.com]

  Treatments include: Anemia treatment Hemoglobin is the substance in red blood cells that carries vital oxygen around the body. If hemoglobin levels are low, the patient has anemia. [medicalnewstoday.com]

  […] due to chronic kidney disease Anemia in chronic kidney dis Anemia in kidney disease Anemia of chronic renal failure Arteriolar nephrosclerosis (kidney disease) Benign arteriolar nephrosclerosis Benign hypertensive heart and chronic renal disease Benign [icd10data.com]

• Fatigue

  Subsequently he developed polyuria, polydipsia, and fatigue with an increase in serum creatinine to 2.8 mg/dL, and random plasma glucose levels elevated to 903 mg/dL. Gatifloxacin was stopped. Intravenous regular insulin infusion was administered. [ncbi.nlm.nih.gov]

  At first, patients may be completely asymptomatic, but signs such as alterations in urinary habits (nocturia), generalized weakness, and fatigue eventually ensue. [symptoma.com]

  Blockage of urinary collecting system (e.g. kidney stones) Chronic infections (e.g. pyelonephritis) Rare genetic disorders (e.g. polycystic kidney disease) Early Stage No clear signs with possible bubbles/blood in urine Mid Stage Loss of appetite Swelling Fatigue [nkfs.org]

• Malaise

  Chronic pulmonary reactions include malaise, dyspnoea, cough, and diffuse interstitial pneumonitis or fibrosis or both 1. [medsafe.govt.nz]

  Symptoms of ESRD include: 1 nocturia malaise anorexia/nausea/vomiting pruritus restless legs dyspnoea Patients with acute renal failure from glomerulonephritis caused by viral infection and immune reaction can present with proteinuria and “nephritic sediment [myhivclinic.org]

  The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. [invokanahcp.com]

  […] taking certain medications History of trauma Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache Stunted growth Malaise [stanfordchildrens.org]

  […] renal failure) Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents (a risk factor for acute renal failure) Chronic: Poor appetite Vomiting Bone pain Headache Insomnia Itching Dry skin Malaise [hopkinsmedicine.org]

• Recurrent Urinary Tract Infection

  […] abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache Stunted growth Malaise High urine output or no urine output Recurrent urinary tract infections Urinary incontinence Pale [stanfordchildrens.org]

  An obstruction or blockage along the urinary tract. A prolonged urinary tract obstruction or blockage. Hemolytic uremic syndrome. [hopkinsmedicine.org]

• Dyspnea

  The last stage of chronic renal failure, termed end-stage renal disease (ESRD), can include all of the mentioned symptoms, as well as muscle wasting, depression, anxiety, constipation, sleep disturbances, restless legs, and dyspnea. [symptoma.com]

  Lack of energy and pruritus are reported by up to 75 percent of patients with stage 5 chronic kidney disease. 16 More than one-half of patients have drowsiness, dyspnea, or edema 16 ; additional symptoms include dry mouth, muscle cramps, restless legs [aafp.org]

  Risk factors Male sex HCV coinfection HIV viral load of >10,000 copies/mL CD4 count of Presence of an opportunistic infection History of an AIDS diagnosis Current or prior ART May be asymptomatic, or may present with volume overload (dyspnea, orthopnea [hiv.va.gov]

  It is unlikely that the three reports of cough among hemodialysis patients are treatment related because there was a higher incidence of respiratory complaints (ie, dyspnea, allergic rhinitis, chronic obstructive pulmonary disease) at study entry among [hyper.ahajournals.org]

• Aspiration

  Immunoelectrophoresis of the urine and bone marrow aspiration indicated multiple myeloma (MM). He was diagnosed with the coexistence of cast nephropathy and light chain deposition disease by a renal biopsy. [ncbi.nlm.nih.gov]

  Uremic patients should be considered “at risk” for aspiration and considered to have a full stomach. [openanesthesia.org]

  However, in seven patients with tense ascites (three in the cefotaxime group and four in the cefotaxime-plus-albumin group), a partial paracentesis, with aspiration of 3 liters, was performed before the resolution of infection. [nejm.org]

• Loss of Appetite

  […] of appetite Swelling Fatigue Late Stage Ammonia breath Loss of appetite/diarrhoea Difficulty breathing Swelling Nausea/vomiting Loss of consciousness Anaemia If the kidney damage is in the early stages, it can be controlled with medication and diet. [nkfs.org]

  […] of Appetite Stomach Pain Headache / Migraine / Dizziness Headaches & Migraines Vertigo Kidney / Bladder / Prostate Bladder Infections / Urinary Tract Infections Prostate Disorders Mood Balancing Burnout Depression vs. [pascoe.ca]

  You may experience the following: Peeing less than normal Swelling in your legs, ankles, and feet (caused by your body holding on to fluid) Drowsiness or feeling very tired Shortness of breath Itching Joint pain, swelling Loss of appetite Confusion Throwing [webmd.com]

• Abdominal Pain

  The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. [invokanahcp.com]

  abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache Stunted growth Malaise High urine output or no urine output Recurrent urinary tract infections Urinary incontinence Pale [stanfordchildrens.org]

  Other symptoms of acute tubular necrosis include tiredness, swelling, lethargy, nausea, vomiting, abdominal pain, kidney pain, loss of appetite, and rash. Sometimes there are no symptoms. [emedicinehealth.com]

  Hemorrhage Fever Weakness Fatigue Rash Diarrhea or bloody diarrhea Poor appetite Severe vomiting Abdominal pain Back pain Muscle cramps No urine output or high urine output History of recent infection (a risk factor for acute renal failure) Pale skin [hopkinsmedicine.org]

  Some causes of pain are specific to renal disease. Polycystic kidney disease can cause chronic abdominal pain. Secondary hyperparathyroidism often results in bone pain. [aafp.org]

• Heart Disease

  Prevention of heart disease, stroke and vascular disease People with kidney disease are at greatly increased risk of heart disease, stroke and problems with the circulation. [edren.org]

  Approximately 75% of patients with T2DM also have hypertension, 4 which increases the risk for cardiovascular (CV) events. 5 Coronary heart disease (CHD) is common in patients with T2DM; heart disease was noted on 68% of diabetes-related death certificates [clinicaladvisor.com]

  Cornfield J (1962) Joint dependence of risk of coronary heart disease on serum cholesterol and systolic blood pressure: a discriminant function analysis. Fed Proc 21:58–61 PubMed Google Scholar 3. [link.springer.com]

  […] condition such as diabetes, heart disease, hypertension, liver disease, or obesity Getting heart surgery or a bone marrow transplant ESRD Compared to CKD Reaching end-stage renal disease means that the patient will no longer be able to survive without [availclinical.com]

  Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as: DO NOT smoke. Eat meals that are low in fat and cholesterol. Get regular exercise (talk to your doctor or nurse before starting to exercise). [nlm.nih.gov]

• Dysgeusia

  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

  The patient presented with acute confusion, muscle cramps and myoclonic jerks 5 weeks after treatment. [ncbi.nlm.nih.gov]

  Possible complications of hemodialysis include muscle cramps and hypotension (sudden drop in blood pressure). Hypotension may cause you to feel dizzy or weak, or sick to your stomach. [hopkinsmedicine.org]

  cramps or restless legs Seeing a doctor when you have stage 3 CKD As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). [davita.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]

  However, you may notice that you: feel more tired and have less energy have trouble concentrating have a poor appetite have trouble sleeping have muscle cramping at night have swollen feet and ankles have puffiness around your eyes, especially in the [kidney.org]

• Bone Pain

  Complications of osteitis fibrosa include any of the following: Bone fractures Deformities of bone Pain Problems due to hyperparathyroidism, such as kidney stones and kidney failure Call your health care provider if you have bone pain, tenderness, or [medlineplus.gov]

  A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. Renal ultrasound (also called sonography). [stanfordchildrens.org]

  Localized bone pain is the leading symptom, often with local swelling and warmth (8). Patients are usually in good general condition. [ncbi.nlm.nih.gov]

  OFC is characterized by the occurrence of bone pain associated with the finding of specific radiographic changes such as increased subperiosteal bone resorption in the distal third of the radius and middle phalanges, distal clavicular thinning, “salt [elsevier.es]

• Osteoporosis

  Denosumab is an emerging new treatment for osteoporosis in postmenopausal women and men with non-metastatic prostate cancer. [ncbi.nlm.nih.gov]

  Article date: April 2010 Zoledronic acid 5 mg for infusion (Aclasta▼) is used for the once-yearly treatment of osteoporosis in patients at increased risk of fracture, and as a single dose for the treatment of Paget’s disease of the bone. [gov.uk]

  People with hyperparathyroidism are more likely to have osteopenia (thin bones) or osteoporosis (very thin bones) than to have full-blown osteitis fibrosa. [medlineplus.gov]

  It is the definitive treatment option for all patients with symptomatic primary HPT or associated with osteoporosis. [hindawi.com]

  Fluoride and osteoporosis. Proceedings of the Society for Experimental Biology and Medicine 191: 278-86. [fluoridealert.org]

• Headache

  / Migraine / Dizziness Headaches & Migraines Vertigo Kidney / Bladder / Prostate Bladder Infections / Urinary Tract Infections Prostate Disorders Mood Balancing Burnout Depression vs. [pascoe.ca]

  […] infection Pale skin History of taking certain medications History of trauma Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache [stanfordchildrens.org]

  Specifically, using VAS to assess headache, there was no correlation between osteitis severity and headache [13▪]. [journals.lww.com]

  Symptoms of kidney disease can include: tiredness loss of appetite difficulty sleeping headaches lack of concentration shortness of breath nausea and vomiting changes in the amount and number of times urine is passed changes in the appearance of urine [betterhealth.vic.gov.au]

  […] of trauma (a risk factor for acute renal failure) Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents (a risk factor for acute renal failure) Chronic: Poor appetite Vomiting Bone pain Headache [hopkinsmedicine.org]

• Lethargy

  He had vague complaints of weakness, lethargy and muscle ache but no urinary symptoms. He was found to have hypothyroidism, and thyroid hormone replacement therapy (THRT) was started which resulted in reversal of the renal dysfunction. [ncbi.nlm.nih.gov]

  Lethargy Weakness Shortness of breath Generalized swelling ( edema ) Generalized weakness due to anemia Loss of appetite Lethargy Fatigue Congestive heart failure Metabolic acidosis High blood potassium ( hyperkalemia ) Fatal heart rhythm disturbances [medicinenet.com]

  Case two A 50-year-old man presented with indigestion, abdominal bloating, weight gain, dry skin and lethargy. His past medical history included laminectomy and longstanding tobacco use. [academic.oup.com]

  Other symptoms of acute tubular necrosis include tiredness, swelling, lethargy, nausea, vomiting, abdominal pain, kidney pain, loss of appetite, and rash. Sometimes there are no symptoms. [emedicinehealth.com]

• Difficulty Concentrating

  concentrating, personality changes or seizures Decreased immune response, which makes you more vulnerable to infection Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium) Pregnancy complications that carry risks [mayoclinic.org]

  This can result in: Feeling tired or weak Memory problems Difficulty concentrating Dizziness Low blood pressure Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. [en.wikipedia.org]

• Insomnia

  […] 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]

  […] trauma (a risk factor for acute renal failure) Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents (a risk factor for acute renal failure) Chronic: Poor appetite Vomiting Bone pain Headache Insomnia [hopkinsmedicine.org]

  […] include: Hypotension ( low blood pressure ) Cough Hyperkalemia (high potassium) Headache Dizziness Fatigue Nausea Skin rash A metallic taste in the mouth Diarrhea Indigestion Abnormal liver function Muscle cramps Aches and pains (myalgia) Back pain Insomnia [emedicinehealth.com]

• Nocturia

  At first, patients may be completely asymptomatic, but signs such as alterations in urinary habits (nocturia), generalized weakness, and fatigue eventually ensue. [symptoma.com]

  Symptoms of ESRD include: 1 nocturia malaise anorexia/nausea/vomiting pruritus restless legs dyspnoea Patients with acute renal failure from glomerulonephritis caused by viral infection and immune reaction can present with proteinuria and “nephritic sediment [myhivclinic.org]

  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]

  Chronic Kidney Disease Symptoms Effects and symptoms of chronic kidney disease include: need to urinate frequently, especially at night (nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood pressure; fatigue and [emedicinehealth.com]

• Renal Function Decreased

  INTRODUCTION: The glomerular filtration rate (GFR), a measure of renal function, decreases by approximately 10 mL/min every 10 years after the age of 40 years, which could lead to the accumulation of drugs and/or renal toxicity. [ncbi.nlm.nih.gov]

Renal impairment, both in the form of acute and chronic renal failure, could be severely harmful and even life-threatening for the patient in the absence of an early diagnosis [1]. For this reason, physicians must obtain a thorough patient history and determine the presence of underlying disorders that may induce renal impairment, whereas a complete physical examination assesses the signs and symptoms and determine the next steps in workup [2]. In fact, the clinical examination can lead to a prompt diagnosis in some cases, examples being prostate hypertrophy and cervical cancer, where the physician might be able to palpate the masses during rectal and vaginal examinations, respectively [1]. As soon as a presumptive diagnosis is made, a meticulous laboratory workup needs to be performed. A complete blood count (CBC), kidney function tests (urea and creatinine), urinalysis, serum glucose levels, complete coagulation panel, serum electrolytes (sodium, potassium, bicarbonate, calcium, and phosphate), inflammatory parameters (erythrocyte sedimentation rate, C-reactive protein), liver transaminases, and in most severe patients, arterial blood gasses must be included [1] [2] [5]. Imaging studies are equally important in determining the cause of kidney failure, with abdominal ultrasonography being the gold standard for evaluation of kidney anatomy and structure [1] [5]. To assess the degree of kidney failure, determination of GFR using creatinine and specific calculations is vital in establishing the severity of renal impairment [1] [5].

• Abnormal Renal Function

  […] of CKD in the general population and the prevalence of these conditions is increasing in HIV-infected people. 5 Abnormal renal function has been shown to be an independent predictor of mortality in people living with HIV (PLWHIV). 6 The higher prevalence [myhivclinic.org]

  Both have low urine concentrations and are not indicated in the treatment of UTI in patients with normal or abnormal renal function. In contrast, ciprofloxacin and levofloxacin achieve high urine concentrations with oral or parenteral therapy. [cjasn.asnjournals.org]

  Background There is a high prevalence (30%) of abnormal renal function among patients with HIV disease. CKD is increasingly a cause of morbidity among people with HIV infection. [hiv.va.gov]

The patient presented with acute confusion, muscle cramps and myoclonic jerks 5 weeks after treatment. [ncbi.nlm.nih.gov]

As renal dysfunction may impact the clinical management of multiple myeloma and is associated with poor prognosis, the preservation of renal function is critical, warranting non-nephrotoxic alternatives where possible in managing this population. © 2017 [ncbi.nlm.nih.gov]

Treatment and prognosis It carries a benign prognosis and may even resolve spontaneously. The main differential diagnosis is a sacroiliitis. [radiopaedia.org]

An accurate history and careful examination will determine the sequence and spectrum of clinical investigations required to make a diagnosis or decide on prognosis or treatment. [oxfordmedicine.com]

This unusual clinical course is useful for further analysis of the etiology of TAFRO syndrome. [ncbi.nlm.nih.gov]

Introduction Osteitis condensans ilii (OCI) is one of the benign etiologies of chronic axial low back pain. Most of the time, OCI is an incidental finding on plain X-ray with ileal sclerosis. [cureus.com]

The underlying etiology is believed to be mechanical stress across the sacroiliac joint. Supporting this hypothesis, it is most often seen in women who have given birth; however, men and nulliparous women can be affected 2-4. [radiopaedia.org]

[…] consequences of renal cyclooxygenase-2 (COX-2) inhibition, the reported cases should draw the attention of doctors and patients to the importance of recognizing any possible signs of renal impairment during nimesulide therapy, although only extensive epidemiological [ncbi.nlm.nih.gov]

Diabetic retinopathy results in up to 24,000 new cases of blindness annually in the United States and is the leading cause of new cases of blindness in adults. 4 Neuropathy due to DM occurs in 60% to 70% of patients with T2DM. 4 Epidemiology of CKD/RI [clinicaladvisor.com]

Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention [revistanefrologia.com]

Several studies have described the pathophysiology of diminished renal function in hypothyroidism. Few studies or case reports have shown total amelioration of renal impairment as seen in our patient. [ncbi.nlm.nih.gov]

[…] kidney disease (CKD), caused directly or indirectly by HIV and/or due to drug-related effects. 1 ARF may be associated with antiretroviral therapy (ART), or treatment for HIV- associated opportunistic infections. 1 CKD disease can be caused by multiple pathophysiological [myhivclinic.org]

Whilst the pathophysiology of impaired renal function in hypothyroidism is multifactorial, the reduction in GFR due to the lower cardiac output and renal blood flow is likely to be the predominant mechanism [ 3 ]. [academic.oup.com]

Still, the pathophysiology of OCI is not clearly understood, but the increased mechanical stress on ileum is considered one of the causative factor of OCI in pregnant women. [cureus.com]

Kidney Diseases Precautions for Healthy Person Precautions for Kidney Patients Prevention of Acute Kidney Failure Prevention of Polycystic Kidney Disease Precautions for Single Kidney Patients Prevention of Kidney Stone Disease Prevention of Urinary [kidneyeducation.com]

Recognition of this unusual finding, and features distinguishing it from other causes of high CSF signal intensity, such as subarachnoid haemorrhage and protein in the CSF, are emphasised to help prevent diagnostic errors. [ncbi.nlm.nih.gov]

1. Fry AC, Farrington K. Management of acute renal failure. Postgrad Med J. 2006;82(964):106-116.
2. Hilton R. Acute renal failure. BMJ : British Medical Journal. 2006;333(7572):786-790.
3. Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004;114(1):5-14.
4. Parmar MS. Chronic renal disease. BMJ. 2002;325(7355):85-90.
5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
6. Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007;14(1):82-99.