The ability of the kidney to reorganize its huge reserve of function means that patients may remain symptomless until the disease is eroding the last 10 per cent of function. Sometimes, patients present with an intermittent illness which seems unduly severe and renal failure may be detected. Some patients develop the complications of renal failure and present with bone pain or hypertension. However, the earliest symptom is usually nocturia. The total urine volume may be increased and this may be associated with thirst. The next symptom to develop is malaise, which often coincides with the development of anaemia. Exercise tolerance is reduced, but remains remarkably good even when the haemoglobin has fallen to 8 or 9 g/dl. In advanced renal failure almost every organ of the body may be affected, and it is useful to consider each separately. However, any one patient may have few of these complications or develop terminal renal failure with no other symptoms than those already described.
KeywordsChronic Renal Failure Secondary Hyperparathyroidism Bone Biopsy Renal Osteodystrophy Analgesic Nephropathy
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