Initial symptoms may include the following:

• Unintentional weight loss
• Nausea, vomiting
• General ill feeling
• Fatigue
• Headache
• Frequent hiccups
• Generalized itching (pruritus)

Later symptoms may include the following:

• Increased or decreased urine output
• Need to urinate at night
• Easy bruising or bleeding
• May have blood in the vomit or in stools
• Decreased alertness
  • drowsiness, somnolence  lethargy
  • confusion  delirium
  • coma
• Muscle twitching or cramps
• Seizures
• Uremic frost -- deposits of white crystals in and on the skin
• Decreased sensation in the hands, feet, or other areas

Additional symptoms that may be associated with this disease:

• Excessive nighttime urination
• Excessive thirst
• Abnormally dark or light skin
• Paleness
• Nail abnormalities
• Breath odor
• High blood pressure
• Loss of appetite
• Agitation

There may be mild to severe high blood pressure. A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.

A urinalysis may show protein or other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear.

• Creatinine levels progressively increase
• BUN is progressively increased
• Creatinine clearance progressively decreases
• Potassium test may show elevated levels
• Arterial blood gas and blood chemistry analysis may show metabolic acidosis

Changes that indicate chronic renal failure, including both kidneys being smaller than normal, may be seen on:

• renal or abdominal x-ray
• abdominal CT scan
• abdominal MRI
• abdominal ultrasound

This disease may also alter the results of the following tests:

• urinary casts
• renal scan
• PTH
• serum magnesium - test
• erythropoietin