[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Kidney, genitourinary, breast and obstetric exam](https://durgical.com/en/clinical-exam/#a-renal) › Uremic syndrome and the signs of chronic kidney disease

[Clinical exam](https://durgical.com/en/clinical-exam/) · [Kidney, genitourinary, breast and obstetric exam](https://durgical.com/en/clinical-exam/#a-renal)

# Uremic syndrome and the signs of chronic kidney disease

- Syndrome

When the kidneys fail, waste builds up in the blood and brings pallor, itching, nausea, bad breath, confusion and high blood pressure.

Updated 2026-11-01

**See it in 3D:** [Kidneys](https://durgical.com/en/anatomy/kidney/)

## Key points

- Uremia = retained toxins + hormonal kidney failure (anemia, bone) + disordered water, sodium, potassium and acid.
- Classic signs: sallow pallor, itching, uremic fetor, asterixis, pericardial rub, Kussmaul breathing.
- Diabetes and hypertension are the leading causes of chronic kidney disease.
- A pericardial rub or uremic encephalopathy are warning signs for urgent dialysis.
- Small kidneys on ultrasound point to chronic disease, except in diabetes, polycystic disease and amyloidosis.

## What it is

Uremic syndrome is the set of symptoms and signs that appear when kidney function falls so far that nitrogenous waste and other toxins are retained and the kidney's hormonal work fails. It touches almost every organ: skin, blood, heart, lungs, gut and nervous system. It is seen mainly in advanced chronic kidney disease and in severe acute kidney injury; recognising it at the bedside flags a patient who may need dialysis.

## Key findings

- Skin: sallow, yellow-grey pallor, itching with scratch marks, easy bruising; 'uremic frost' is rare and late.
- Nails: white proximal half and brown distal half ('half-and-half' nails).
- Breath smelling of urine or ammonia (uremic fetor), nausea, vomiting, poor appetite and persistent hiccups.
- Heart and lungs: hypertension, edema, crackles from overload, a pericardial friction rub from uremic pericarditis, Kussmaul breathing from acidosis.
- Nervous system: drowsiness, confusion, asterixis, cramps, restless legs and a stocking-pattern peripheral neuropathy; in severe cases seizures and coma.
- Other: bleeding from platelet dysfunction, sexual dysfunction, menstrual changes, bone pain; look for an arteriovenous fistula or a dialysis catheter.

## Pathophysiology

- The fall in glomerular filtration retains urea, creatinine and other molecules ('uremic toxins') that disturb platelets, nerves and serous membranes.
- The kidney stops making enough erythropoietin: a normocytic anemia appears, with pallor and fatigue.
- Vitamin D activation fails and phosphate is retained: calcium falls, parathyroid hormone rises and bone is affected (mineral and bone disorder).
- Sodium and water retention causes hypertension, edema and lung congestion; acid retention causes metabolic acidosis with deep breathing.
- Reduced potassium excretion causes hyperkalemia, which can trigger dangerous arrhythmias.

## Common causes

- Advanced chronic kidney disease: in Colombia and the region the leading causes are diabetes and high blood pressure.
- Other causes of chronic kidney disease: glomerulonephritis, polycystic kidneys, obstructive uropathy (prostate, stones) and drug-induced interstitial nephritis.
- Severe acute kidney injury: shock, sepsis, dehydration, nephrotoxins, rhabdomyolysis or urinary tract obstruction.
- Signs that warn of a need for urgent dialysis: pericardial rub, encephalopathy, fluid overload that does not respond, and severe hyperkalemia or acidosis.

## Tests that confirm it

- Raised creatinine and urea; estimated glomerular filtration rate to stage chronic kidney disease.
- High potassium, low bicarbonate, low calcium, high phosphate and parathyroid hormone, low hemoglobin.
- Urinalysis with proteinuria or albuminuria, which appears before symptoms.
- Renal ultrasound: small, echogenic kidneys in chronic disease; they may be normal or large in diabetes, polycystic disease and amyloidosis.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is a patient with advanced chronic kidney disease anemic?

Because the kidney makes less erythropoietin, the hormone that drives red cell production.

## Which breathing pattern does uremic metabolic acidosis cause?

Kussmaul breathing: deep and fast, to blow off carbon dioxide.

## What does a pericardial friction rub mean in a uremic patient?

Uremic pericarditis, a warning sign that usually means urgent dialysis is needed.

## What are the two leading causes of chronic kidney disease in Colombia?

Diabetes mellitus and high blood pressure.

## Which ultrasound finding points to chronic kidney disease, and what are the exceptions?

Small, echogenic kidneys; diabetes, polycystic disease and amyloidosis can keep the kidneys normal-sized or large.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/clinical-exam/uremic-syndrome-and-the-signs-of-chronic-kidney-disease/)

## See it in 3D

The structures of Durgical's 3D anatomy where it is found.

- [Kidneys](https://durgical.com/en/anatomy/kidney/)

## Related

- [Nephrotic vs nephritic syndrome](https://durgical.com/en/clinical-exam/nephrotic-vs-nephritic-syndrome/)
- [Urinary symptoms: dysuria, frequency, oliguria and hematuria](https://durgical.com/en/clinical-exam/urinary-symptoms-dysuria-frequency-oliguria-and-hematuria/)
- [Pallor, cyanosis and jaundice](https://durgical.com/en/clinical-exam/pallor-cyanosis-and-jaundice/)
- [Edema: pitting, grading and distribution](https://durgical.com/en/clinical-exam/edema-pitting-grading-and-distribution/)
- [Respiratory rate and breathing patterns](https://durgical.com/en/clinical-exam/respiratory-rate-and-breathing-patterns/)
- [Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rub](https://durgical.com/en/clinical-exam/adventitious-sounds-crackles-wheezes-rhonchi-stridor-and-pleural-rub/)
- [Anemia syndrome](https://durgical.com/en/clinical-exam/anemia-syndrome/)
- [Kidney palpation: bimanual palpation and ballottement](https://durgical.com/en/clinical-exam/kidney-palpation-bimanual-palpation-and-ballottement/)

## Related conditions

- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)
- [Acute kidney injury](https://durgical.com/en/conditions/acute-kidney-injury/)
- [CKD-mineral and bone disorder (renal osteodystrophy)](https://durgical.com/en/conditions/ckd-mineral-and-bone-disorder/)
- [Diabetic kidney disease](https://durgical.com/en/conditions/diabetic-kidney-disease/)
- [Fluid volume overload (hypervolaemia)](https://durgical.com/en/conditions/fluid-volume-overload/)
- [Autosomal dominant polycystic kidney disease](https://durgical.com/en/conditions/autosomal-dominant-polycystic-kidney-disease/)
- [Rhabdomyolysis](https://durgical.com/en/conditions/rhabdomyolysis/)

[← All of the clinical exam](https://durgical.com/en/clinical-exam/)

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: [Chronic kidney disease: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000471.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [Urine output - decreased](https://medlineplus.gov/ency/article/003147.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [25.3 Gross Anatomy of the Kidney - Anatomy and Physiology 2e | OpenStax](https://openstax.org/books/anatomy-and-physiology-2e/pages/25-3-gross-anatomy-of-the-kidney) (OpenStax, 2022).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/clinical-exam/uremic-syndrome-and-the-signs-of-chronic-kidney-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/uremic-syndrome-and-the-signs-of-chronic-kidney-disease/