-
Quite early in the progression of kidney failure the ability to
concentrate and dilute the urine becomes impaired.
-
Polyuria,
nocturia, and thirst when GFR is about 30 ml/min.
-
Sodium
retention and increased extracellular fluid volume.
-
Hypertension,
present in 80 per cent of patients in late chronic renal failure.
-
Urinary sodium
leak and sodium depletion on a normal sodium diet (
present in few patients with early chronic renal
failure, usually with diseases affecting the renal medulla;
for example, obstructive uropathy and medullary
cystic disease).
-
Weakness in pelvic and shoulder
girdle muscles.
-
Serious electrocardiographic
abnormalities and cardiac arrhythmias.
-
Hyperkalaemia.
-
Acidosis (requires treatment if
the bicarbonate concentration is less than 15 mmol/L and the pH
less than 7.30).
-
Endocrine dysfunction, for example
reduced production of 1,25-dihydroxy vitamin D and
erythropoietin.
-
Bone pain
-
fatigue and itching,
as
glomerular filtration decreases to 25% or less of normal
-
Uraemic syndrome, manifestations
include encephalopathy, glucose intolerance, platelet
dysfunction, anaemia, and leucocyte dysfunction.
-
Plasma growth-hormone levels are
abnormally high in patients in kidney failure.
-
Prolactin levels are high in
kidney failure and may contribute to gynaecomastia and sexual
dysfunction in men.
-
Testosterone levels are often low
to normal in males, but gonadotrophins are raised.
-
Oestrogen deficiency in women.
-
In
the end stages,
more severe
features develop including problems with the heart, lungs,
intestines and the nervous system.
