Clinical Features

• Hypertension and heart failure

• Pulmonary and peripheral edema

• Definition: Uremia is defined as the accumulation of toxic substances due to decreased renal excretion. These toxic substances are mostly metabolites of proteins such as urea, creatinine, β2 microglobulin, and parathyroid hormone.

• Constitutional symptoms

  • Fatigue

  • Weakness

  • Headaches

• Gastrointestinal symptoms

  • Nausea and vomiting

  • Loss of appetite

  • Uremic fetor: characteristic ammonia- or urine-like breath odor

• Dermatological manifestations

  • Pruritus

  • Skin color changes (e.g., hyperpigmentation, pallor due to anemia)

  • Uremic frost: uremia leads to high levels of urea secreted in the sweat, the evaporation of which may result in tiny crystallized yellow-white urea deposits on the skin.

• Serositis

  • Uremic pericarditis: a complication of chronic kidney disease that causes fibrinous pericarditis

    • Clinical features: chest pain worsened by inhalation

    • Physical examination findings

      • Friction rub on auscultation

      • ECG changes normally seen in nonuremic pericarditis (e.g., diffuse ST-segment elevation) are not usually seen.

  • Pleuritis

• Neurological symptoms

  • Asterixis

  • Signs of uremic encephalopathy

    • Seizures

    • Somnolence

    • Coma

  • Peripheral neuropathy → paresthesias

• Hematologic symptoms

  • Anemia

  • Leukocyte dysfunction → ↑ risk of infection

  • ↑ Bleeding tendency caused by abnormal platelet adhesion and aggregation [9]

Kidney OUTAGES: hyperKalemia, renal Osteodystrophy, Uremia, Triglyceridemia, Acidosis (metabolic), Growth delay, Erythropoietin deficiency (anemia), Sodium/water retention (consequences of chronic kidney disease)