Physical Signs of Advanced Kidney Failure


Advanced kidney or renal failure is the final stage of chronic kidney disease, necessitating dialysis or a kidney transplant. Many people are unaware that a problem has developed prior to the physical manifestation of advanced kidney failure. With knowledge of the warning symptoms and early treatment, however, you may be able to avoid the most dire consequences of this disease.


Although chronic kidney disease (CKD) can develop among all demographics, people with untreated hypertension, diabetes, obesity and a family history of kidney disease are at highest risk. The rate of CKD is also elevated among Native Americans, African-Americans, Pacific Islanders, Hispanics and the elderly.

CKD occurs when an individual suffers from a gradual and usually permanent loss of kidney function over time. The kidneys are over-taxed and are unable to properly process liquid wastes and carry out other important functions, including regulating levels of calcium, sodium, phosphorus and potassium in the blood.

Top 10 Physical Signs

The most common physical signs of advanced kidney failure are swelling, changes in urination, fatigue and anemia, vomiting and nausea, shortness of breath, pain in the legs and back, dizziness and difficulty concentrating, chills, bad or "metallic breath, and itching and rashes.


Water bloats the body when the kidneys, unable to properly process fluids, cause the legs, ankles and face to swell. You may notice difficulty getting shoes on that normally fit and puffiness around the eyes, particularly in the morning. This condition—known as edema—is one of the main physical signs of advanced kidney failure.


You may notice a change in urination patterns, including an increased need to urinate during the night, although this can also be a symptom of prostate, bladder and other health concerns. Sometimes the flow of urine will be much greater than usual, while at other times what feels like a dire need to urinate may result in nothing more than a few drops. The urine may be bubbly or foamy, cloudy, pale or mixed with traces of blood. Some people will see the color darken when heavier concentrations of blood are present.

Fatigue and Anemia

The kidneys produce a hormone called erythropoietin that encourages the body to build oxygen-carrying red-blood cells. As the kidneys fail, the transport of oxygen is restrained, causing the brain and muscles to tire, and anemia can result. Dizziness and a lack of concentration are by-products of the brain's inability to function properly with reduced oxygen levels. Shortness of breath is also related to both anemia and a buildup of fluid in the lungs, and chills and a sensation of being cold are further symptoms of anemia.

Metallic Breath

A physical sign of advanced kidney failure may include a metallic taste in the mouth accompanied by breath that smells like ammonia. This is a symptom of increased waste, called uremia, in the blood. This may be accompanied by a loss of appetite, and foods may taste differently and some individuals may feel inclined to avoid the consumption of meat.

Other Signs

Dry skin, rashes and heavy itching are signs of excessive wastes circulating in the bloodstream. You may experience a constant itching sensation that feels as if it penetrates to the bone. Elevated levels of toxins in the body also cause nausea and vomiting as the system frantically moves to eliminate accumulated poisons. Increased pain in the legs, flanks or back may be tied to damaged kidneys and often is a sign of a specific type of kidney disorder called polycystic kidney disease.

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