Thus, the plasma Na concentration is typically normal and hypervolemia is infrequent despite unmodified dietary intake of Na. However, imbalances may occur if Na and water intakes are very restricted or excessive. Symptoms and Signs Patients with mildly diminished renal reserve are asymptomatic, and renal dysfunction can be detected only by laboratory testing. Lassitude, fatigue, and decreased mental acuity often are the first manifestations of uremia. Anorexia, nausea, vomiting, stomatitis, and an unpleasant taste in the mouth are almost uniformly present.
Malnutrition leading to generalized tissue wasting is a prominent feature of chronic uremia.
In advanced CRF, GI ulceration and bleeding are common. Pericarditis, usually seen in chronic uremia, may occur in acute, potentially reversible, uremia. Pruritus is especially uncomfortable for some patients. Abnormalities with lipid metabolism also occur with CRF, on dialysis, and after renal transplantation. This may occur even if the underlying disorder is not active.