Clinical Abnormalities in Uremia

I= Improves after dialysis, P = Persists, D = Due to dialysis

Fluid and electrolyte disturbances Volume expansion (I) Hyponatremia (I) Hyperkalemia (I) Hyperphosphatemia (I) Endocrine-metabolic disturbances Secondary hyperparathyroidism (I or P) Adynamic bone (D) Vitamin D–deficient osteomalacia (I) Carbohydrate resistance (I) Hyperuricemia (I or P) Hypertriglyceridemia (I or P) Increased Lp(a) level (P) Decreased high-density lipoprotein level (P) Protein-energy malnutrition (I or P) Impaired growth and development (P) Infertility and sexual dysfunction (P) Amenorrhea (I/P) beta 2-Microglobulin associated amyloidosis (P or D)

Neuromuscular disturbances Fatigue (I)b Sleep disorders (P) Headache (P) Impaired mentation (I)b Lethargy (I)b Asterixis (I) Muscular irritability Peripheral neuropathy (I or P) Restless legs syndrome (I or P) Myoclonus (I) Seizures (I or P) Coma (I) Muscle cramps (P or D) Dialysis disequilibrium syndrome (D) Myopathy (P or D) Cardiovascular and pulmonary disturbances Arterial hypertension (I or P) Congestive heart failure or pulmonary edema (I) Pericarditis (I) Hypertrophic or dilated cardiomyopathy (I, P, or D) Uremic lung (I) Accelerated atherosclerosis (P or D) Hypotension and arrhythmias (D) Vascular calcification (P or D)

Dermatologic disturbances Pallor (I)b Hyperpigmentation (I, P, or D) Pruritus (P) Ecchymoses (I) Nephrogenic fibrosing dermopathy (D) Uremic frost (I) Gastrointestinal disturbances Anorexia (I) Nausea and vomiting (I) Gastroenteritis (I) Peptic ulcer (I or P) Gastrointestinal bleeding (I, P, or D) Idiopathic ascites (D) Peritonitis (D) Hematologic and immunologic disturbances Anemia (I)b Lymphocytopenia (P) Bleeding diathesis (I or D)b Increased susceptibility to infection (I or P) Leukopenia (D) Thrombocytopenia (D)

^aVirtually all abnormalities in this table are completely reversed in time by successful renal transplantation. The response of these abnormalities to hemodialysis or peritoneal dialysis therapy is more variable. (I) denotes an abnormality that usually improves with an optimal program of dialysis and related therapy; (P) denotes an abnormality that tends to persist or even progress, despite an optimal program; (D) denotes an abnormality that develops only after initiation of dialysis therapy.

^bImproves with dialysis and erythropoietin therapy.

Note: Lp(a), lipoprotein A.