Symptoms:

• Abdominal swelling due to fluid (called ascites, a symptom of the underlying liver disease)
• Change in mental status
  • Confusion
  • Delirium
  • Dementia
• Coarse muscle movements or mucle jerks
• Dark-colored urine (a symptom of the underlying liver disease)
• Decreased urine production
• Nausea and vomiting
• Weight gain
• Yellow skin (jaundice, a symptom of the underlying liver disease)

Signs and tests:

This condition is diagnosed when other causes of kidney failure are ruled out by the appropriate tests.

A physical examination does not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease:

• Confusion (often due due to hepatic encephalopathy)
• Excess fluid in the abdomen (ascites)
• Jaundice
• Other signs of liver failure

Other signs include:

• Abnormal reflexes
• Decreased testicle size
• Dull sound in the abdomen when tapped with the tips of the fingers, and visible fluid wave when examined by feel
• Increased breast tissue (gynecomastia)
• Sores (lesions) on the skin

The following may be signs of kidney failure:

• Absent or low urine production, less than 400 cc/day
• Fluid retention in the abdomen or extremities
• Increased BUN and serum creatinine levels
• Increased urine specific gravity and osmolality
• Low serum sodium
• Very low urine sodium concentration

The following may be signs of liver failure:

• Abnormal prothrombin time (PT)
• Increased serum ammonia levels
• Low serum albumin
• Paracentesis shows ascites
• Signs of hepatic encephalopathy (an EEG may be performed if such signs are present)