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==History and symptoms==
==History and symptoms==


Initially it is without specific symptoms and can only be detected as an increase in serum [[creatinine]]. As the [[kidney]] function decreases:
*General ill feeling and [[fatigue]]
* [[Blood pressure]] is increased due to fluid overload and production of vasoactive hormones leading to [[hypertension]] and[[congestive heart failure]]
*Generalized itching ([[pruritus]]) and [[dry skin]]
* [[Urea]] accumulates, leading to [[azotemia]] and ultimately [[uremia]] (symptoms ranging from lethargy to [[pericarditis]] and[[encephalopathy]])
*[[Headaches]]
* [[Potassium]] accumulates in the blood (known as [[hyperkalemia]] with symptoms ranging from [[malaise]] to fatal [[cardiac arrhythmia]]s)
*Weight loss without trying
* [[Erythropoietin]] synthesis is decreased (leading to [[anemia]] causing [[fatigue (physical)|fatigue]])
*[[Anorexia]]
* [[Fluid balance|Fluid volume overload]] - symptoms may range from mild [[edema]] to life-threatening [[pulmonary edema]]
*[[Nausea]]
* [[Hyperphosphatemia]] - due to reduced phosphate excretion, associated with [[hypocalcemia]] (due to [[vitamin D3]] deficiency).
Other symptoms may develop, including:
** Later this progresses to [[tertiary hyperparathyroidism]], with [[hypercalcaemia]], [[renal osteodystrophy]] and vascular calcification
*Abnormally dark or light skin and changes in nails
* [[Metabolic acidosis]], due to decreased generation of [[bicarbonate]] by the kidney, leads to uncomfortable breathing and further worsening of bone health.
*Bone pain
CRF patients suffer from accelerated [[atherosclerosis]] and have higher incidence of [[cardiovascular disease]], with a poorer prognosis.
Nervous system symptoms:
 
*Drowsiness and [[confusion]]
In many CRF patients, previous renal disease or other underlying diseases are already known. A small number presents with CRF of unknown cause. In these patients, a cause is occasionally identified retrospectively. 
*Inability to concentrate
 
*Numbness in the hands, feet, or other areas
It is important to differentiate CRF from [[acute renal failure]] (ARF) because ARF can be reversible. Abdominal [[medical ultrasonography|ultrasound]] is commonly performed, in which the size of the [[kidney]]s are measured.  Kidneys in CRF are usually smaller (< 9 cm) than normal kidneys with notable exceptions such as in [[diabetic nephropathy]] and [[polycystic kidney disease]].  Another diagnostic clue that helps differentiate CRF and ARF is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks). If these levels are unavailable (because the patient has been well and has had no blood tests) it is occasionally necessary to treat a patient briefly as having ARF until it has been established that the renal impairment is irreversible.
*Muscle twitching or cramps
 
*Breath odor
Numerous uremic toxins (see link) are accumulating in chronic renal failure patients treated with standard dialysis. These toxins show various cytotoxic activities in the serum, have different molecular weights and some of them are bound to other proteins, primarily to albumin. Such toxic protein bound substances are receiving the attention of scientists who are interested in improving the standard chronic dialysis procedures used today.
*Easy bruising, nosebleeds, or blood in the stool
*Excessive thirst
*Frequent hiccups
*Loss of [[libido]] and [[impotence]]
*[[Amenorrhea]]
*Sleep problems, such as [[insomnia]], [[restless leg syndrome]], or [[obstructive sleep apnea]]
*[[Edema]] of hands and feet
*[[Vomiting]], especially in the morning


==[[References]]==
==[[References]]==

Revision as of 18:56, 22 July 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

History and symptoms

Other symptoms may develop, including:

  • Abnormally dark or light skin and changes in nails
  • Bone pain

Nervous system symptoms:

References


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