While a few patients with failing kidneys can make it almost all the way to renal failure without getting symptomatic, most patients experience a cluster of symptoms that get progressively worse. These symptoms indicate that azotemia is developing. Medicinenet.com defines azotemia as "higher than normal blood level of urea or other nitrogen containing compounds in the blood."
Odors
Very advanced patients may begin to give off an odor that smells vaguely of urine. This odor does not go away regardless of how frequently patients shower. This happens because wastes that would normally be filtered out by the kidneys are getting secreted through the skin. In some instances, patients may have a foul taste in their mouths as well. These symptoms are eliminated by dialysis or transplant.
Anemia
Anemia can develop in some patients because the kidneys' ability to make erythropoietin becomes impaired. Erythropoietin is responsible for the maturation of red blood cells (RBCs). Since immature RBC cannot carry oxygen, anemic patients are often fatigued and out of breath. Fortunately, this symptom is manageable by regular injections of genetically engineered erythropoietin.
Bone Issues
Bone weakness can be a problem in patients with advanced disease because the kidneys lose the ability to regulate levels of phosphorus in the blood. While elevated phosphorus doesn't cause problems other than itching and possibly red eye in the short term, it can cause serious problems in the long term because it causes calcium loss from bones. This issue can be monitored through blood tests. Dietary changes may be necessary if issues arise.
Cardiovascular Disease
In her article entitled "Cardiovascular Disease in Patients with Chronic Renal Failure: The Cardio-Renal Axis," Dr. Susana G. Pereza states that patients with chronic kidney disease are more like to die of cardiovascular disease (CVD) than they are of chronic kidney disease. The high incidence of CVD correlates with the high rate of hypertension among kidney patients. As kidneys become progressively scarred, they sense less blood flow and respond by secreting more angiotensin, a hormone that raises blood pressure by constricting the blood vessels. Kidney patients often end up taking several blood pressure medications to get this problem under control.
