The patient complains of marked loss of appetite, nausea and recurrent vomiting (especially in the morning). These are the early symptoms, and the patient may report only with these vague complaints, and at such a stage, it is only the clinician who can clinch the diagnosis, provided the patient reports to him well in time.

The taste of the mouth gets altered. A marked ulceration may follow in the mouth as well as in the stomach and/ orintestine, leading to haemorrhage in both the stomach and the intestine, causing--vomiting of blood (haematemesis) or the passing of blood in stools (melaena). There is a marked pain in the abdomen and the patient usually reports as a case of bleeding peptic ulcer. Loss of fluids, as a result of vomiting/ haemorrhage, further deteriorates kidney functions as a result of dehydration. Hiccoughs are another symptom as the disease progresses.

In addition, blood pressure rises as a result of the damage to the kidneys, called 'renal hypertension'. Sometimes, the patient may be already suffering from high blood pressure, which may have contributed to the injury to the kidneys. Further, heart failure may occur due to the persistent elevation of blood pressure. In advanced cases, the pericardium, i.e. the membrane covering the heart may also be involved (pericarditis) .

Fall in haemoglobin (chronic anaemia) becomes a constant feature of CRE As the blood urea/serum creatinine rises, haemoglobin falls accordingly, and both are so corelated that even an estimation of haemoglobin, which is a simple test, can indicate the progress of the disease. The fall in haemoglobin occurs due to the toxic effect on the bone marrow, which gets depressed, as well as due to haemorrhages in the stomach/ intestine, etc. Anaemia is difficult to treat as the patient cannot tolerate oral iron due to constant nausea, vomiting and ulceration in the gastrointestinal tract.

Soon the lungs may be affected, and the patient may experience difficulty in breathing (uraemic lungs).

In the same way, the bones may be affected (renalosteodystrophy), and, likewise, the peripheral nerves may be involved (neuropathy), and there may develop a marked weakness in the muscles (myopathy), and a number of other conditions like muscle twitches / tremors etc. may show up.

The brain or the central nervous system may be involved, leading to drowsiness and even coma. CRF or uraemia is one of the important causes of coma:

Sometimes epilepsy/epileptic fits may also manifest itself. Epilepsy may be the only presenting signal of CRF, i.e. the patient can present himself as a case of epilepsy, and if blood ureal serum creatinine estimation is done, his blood urea may be as high as 400 mg/ dl, and likewise there will be a higher level of serum creatinine. Although such cases are not common, the estimation of blood urea/serum creatinine in all cases of epilepsy may prove rewarding, in excluding advanced cases of CRF.

There may also occur high levels of blood uric acid (hyperuricaemia), as a result of blood uric acid not being excreted by the kidneys fully. This results in the various complications of high blood uric acid. Marked itching (pruritus) of the whole body adds to the misery of the patient, and it hardly responds to any treatment.

Hence, as a result of CRF, almost every part of the body gets significantly involved, threatening the life of the patient.