Symptoms of Kidney Disease

Signs are often missed until damage has occurred

chronic kidney disease symptoms

 Illustration by Verywell 

Chronic kidney disease (CKD) is an umbrella term used to describe a longstanding disease or condition that causes the progressive loss of kidney (renal) function. The primary functions of the kidneys are to excrete waste and regulate the water and acid-base balance of the body. Without these functions, a person cannot survive. While there are many different causes of CKD—including diabetes, hypertension, infection, and autoimmune diseases—the symptoms will often be similar irrespective of the underlying condition. 

Depending on the stage of the disease, you may experience non-specific symptoms such as fatigue, malaise, nausea, and the loss of appetite alongside more characteristic signs such as kidney pain, foamy urine, and breath that smells of ammonia.

Over time, the progressive loss of kidney function can trigger a domino-like cascade of symptoms affecting the heart, lungs, brain, bones, and other organs.

Frequent Symptoms

Symptoms of CKD are often missed in the early stages of the disease and, in many cases, will be entirely invisible until significant damage has been done. Unlike an acute kidney injury (AKI), in which the symptoms appear abruptly and are often reversible, CKD is characterized by progressive and permanent damage over the course of months and years.

The symptoms of CKD develop as the kidneys are less able to filter water and waste from the blood. The accumulation of these and other excretory substances (such as uric acid, calcium, and albumin) can throw off the normal balance of acids and electrolytes in the body and interfere with circulation, blood pressure, digestion, respiration, and even brain activity.

Moreover, as the kidneys start to fail, they will stop producing a hormone called erythropoietin, which tells the body how to make erythrocytes (red blood cells). The depletion of these oxygen-carrying cells is referred to as anemia.

The impairment of kidney function can cause characteristic symptoms such as:

  • Cold intolerance (feeling cold all the time)
  • Difficulty urinating
  • Dizziness and lightheadedness
  • Dysgeusia (metallic taste)
  • Dyspnea (shortness of breath)
  • Easy bruising
  • Facial edema (swelling of the face)
  • Fatigue
  • Foamy urine (due to excess protein in the urine)
  • Loss of concentration
  • Nausea and vomiting
  • Nocturia (frequent urination at night)
  • Pain in the legs and upper back
  • Peripheral edema (swelling of the extremities, particularly the hands, ankles, and feet)
  • Pruritus (itchiness)
  • Uremia fetor (ammonia breath)

Complications

As CKD progresses and your kidney function falls below 25 percent of its normal value, the range of symptoms will become severe.

As part of an interrelated system, the loss of kidney function will invariably affect all other organs systems. Without the means to filter blood and clear waste, even beneficial substances can accumulate to toxic levels, leading to such metabolic complications as hypercalcemia (excessive calcium), hyperkalemia (excessive potassium), hyperphosphatemia (excessive phosphate), and uremic toxicity (excessive uric acid).

The interrelationship between the kidneys and other organs makes for health concerns that often beget other health concerns.

For example, high blood pressure—a common cause of CKD—can place persistent stress on the kidney, causing damage and the development of renal hypertension (high blood pressure of the kidneys). This, in turn, can further increase blood pressure and promote the development of atherosclerosis (the hardening of the arteries) and coronary artery disease.

The consequences of these metabolic imbalances can be far-ranging and severe. Among them:

  • Hypercalcemia can cause excessive urination, kidney stones, lethargy, loss of appetite, mental confusion, nocturia, weakness, fainting, and coma.
  • Hyperkalemia can cause chest pain, dyspnea, malaise, muscle weakness, nausea, numbness, palpitation, slowed heart rate, weak pulse, and sudden cardiac death.
  • Hyperphosphatemia can cause bone pain, muscle cramps, joint pain, and pruritus.
  • Renal hypertension can cause blurry vision, confusion, double vision, dyspnea, headaches, nausea, nosebleeds, vomiting, wheezing, and pulmonary edema (a build-up of fluid in the lungs).
  • Uremic toxicity can cause abdominal pain, bone demineralization, chest pain, erectile dysfunction, hematuria (blood in the urine), insomnia, irregular periods, loss of libido, memory loss/confusion, peripheral neuropathy ("pins and needles" sensations), pericarditis (inflammation of the heart), personality changes, seizures, and coronary artery disease.

End-Stage Renal Disease

The biggest concern arises when the kidneys start to shut down, a condition referred to as renal failure or end-stage renal disease (ESRD). ESRD requires that a patient get dialysis or a kidney transplant to survive.

Without life-sustaining interventions, toxins can build up quickly, causing a condition called uremia. Death usually follows within a few days to several weeks. If the decision is made not to pursue dialysis, palliative care is needed to ensure that the individual is as comfortable as possible during his or her final days.

End-stage symptoms typically include:

  • Loss of appetite
  • Restlessness
  • Sleeping throughout most of the day
  • Disorientation and confusion
  • Hallucinations
  • Accumulation of fluid in the lungs
  • Changes in respiration
  • Changes in skin color and temperature

Cardiac arrest is the most common cause of death in people with ESRD. Other possible causes include infection, sepsis, stroke, and hemorrhage.

When to See a Doctor

The symptoms of CKD are often non-specific and generalized, meaning that they can be mistaken for any number of other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, the signs and symptoms may not be apparent until irreversible damage has occurred.

To this end, it is important to identify your personal risk factors and to see a doctor if you experience any symptoms suggestive of CKD.

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