The general picture of uremia

The clinical presentation and manifestations of uremia that constitute the uremic syndrome are presented. The first descriptions of patients with advanced or "terminal" renal failure who were treated with hemodialysis are evoked to illustrate the wide range of signs and symptoms that are associated even to a moderate decrease in renal function, presently referred to as chronic kidney disease (CKD) stages 3-4. The kidney is a central organ guaranteeing the maintenance of the "milieu intérieur," where all the cells of the body are generated, develop, proliferate, and die. Chronic kidney disease, by altering the "milieu intérieur," may alter the metabolism of every type of cell or organ, leading to a wide scope of symptoms. The most frequently observed signs in daily clinical practice are summarized and put into the perspective of the renal physician. Disturbances of ion and water metabolism, hypertension, cardiovascular disease, anemia, mineral and bone disorders, endocrine, inmmunologic and neurologic syndromes are described. The addition of these clinical manifestations defines and describes each uremic patient as a specific individual. The pathophysiologic mechanisms by which each of these signs and symptoms appears and the particular compounds responsible for their occurrence, are described in depth in subsequent chapters of this issue.