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Nonspecific Symptoms

Most symptoms of kidney failure are nonspecific, meaning they occur in a variety of conditions, including kidney failure. For example, the most common symptoms are loss of appetite, nausea and vomiting. However, these symptoms can occur in patients with a flu-like syndrome totally unrelated to kidney disease, with food poisoning, or a variety of other common conditions. Loss of appetite, even before nausea and vomiting may occur, is a significant problem since it may lead to inadequate dietary protein intake.

Constitutional Symptoms

The second most common group of symptoms, called constitutional symptoms, are very subjective and are not confined to one part of the body or organ system. These include fatigue (which may be constant or represent a low tolerance for physical activity), difficulty concentrating, memory loss and sleep disorders. Many of these symptoms may be related as much to anemia as to the accumulation of toxins resulting from the diseased kidney’s failure to excrete them.

Fluid Retention

The third most common symptom is fluid retention leading to high blood pressure, swelling and shortness of breath. Patients with kidney disease, even advanced kidney disease, maintain their ability to urinate well after starting dialysis. Because of what appears to be a normal urine volume, many patients are surprised when they are told their kidneys are not working normally because they expect this to be associated with a decreased production of urine. However, even a small imbalance between salt and water intake, and the amount of salt and water excreted in the urine, can lead to progressive accumulation of fluid over time. In its early stages, this is treated with dietary sodium restriction and diuretic drugs. However, in advanced stages of kidney disease, these treatments may no longer be sufficient and dialysis may be the only effective option. Therefore, any patient with CKD who notices the development of tissue swelling, shortness of breath, or an increased difficulty with blood pressure control should promptly seek medical attention to determine the most appropriate treatment.

There are a variety of signs and symptoms that often occur in patients with kidney failure. These include itching, which tends to affect the whole body and may be related to high blood phosphorus and calcium levels. This may respond to lowering of serum phosphorus levels with the use of a phosphate binder and dietary phosphate restriction.

However, in some patients, itching persists despite correction of serum calcium and phosphorus levels, and is thought to represent irritation of the small nerves in the skin (neuropathy) due to the accumulation of toxins not being eliminated by the damaged kidneys. In this situation, dialysis may be the only effective treatment. Another form of neuropathy may lead to tingling in the hands and feet, a symptom that is also not specific for kidney disease and which may be seen in patients with neuropathy due to diabetes, chronic alcoholism and certain vitamin deficiencies. If these other causes of neuropathy have been eliminated, dialysis is the treatment of choice for the peripheral neuropathy associated with kidney failure.

In summary, most of the signs and symptoms of kidney failure are not specific to patients with kidney disease and may be seen in a variety of other conditions. Therefore, it is recommended that should any of these symptoms appear, the patient promptly seek medical attention to determine the cause rather than assuming it is due to kidney failure. In many situations, these symptoms can be effectively treated with medications and other forms of medical management, and do not necessarily indicate the need for dialysis. The decision to start dialysis is based on the combination of symptoms and laboratory values. When any of these symptoms appear, the patient should discuss the implications and therapeutic alternatives thoroughly with his or her nephrologist and, based on each patient’s unique clinical, laboratory and lifestyle issues, a fully informed decision can be made regarding the best treatment plan.

http://www.aakp.org/aakp-library/Signs-your-Kidneys-May-be-Failing/