Kidney Disease Tongue Symptoms: What to Watch Out For?

What causes kidney disease?

Kidneys are a pair of bean-shaped organs, each kidney is about the size of a fist. The kidneys are organs that filter wastes and extra water out of the body in order to produce urine and blood. Kidney disease means that the kidneys are damaged and not filtering blood properly.1 The primary risk factors for developing kidney disease are diabetes, high blood pressure, and heart disease. Diabetes causes high blood sugar levels that damage the kidney’s filters over time and impair their function.2 High blood pressure damages and weakens the kidney's small blood vessels if not controlled.3 When small vessels are damaged, the kidneys cannot filter blood the way they should. Both kidney disease and heart disease share the same two main causes which are blood pressure and diabetes.4

Signs of kidney problems 

  1. Changes in Urination

One sign of kidney disease is the increased need to urinate, particularly at night. The increased urge to pee is caused as a result of kidney’s filter damage, however, it can also be a sign of urinary infection or enlarged prostate in men. Another sign of kidney problems is foamy urine with excessive foams that need to be flushed several times to go away. Foamy urine is a sign of the presence of protein in the urine. Blood in the urine may be a warning sign of kidney’s filter damage. The kidney leaks out blood cells instead of keeping them in the body when filtering the blood to create urine. Blood in the urine can also be a sign of infection, kidney stones, and tumors.5 

  1. Swelling 

Sodium retention occurs when kidney functions decrease causing excess fluid builds up in the body instead of being filtered out and passed on as urine. As these fluids build up, those with CKD may experience swelling in their hands, feet, and legs.5,6 These symptoms can be controlled with medication and by reducing your sodium intake. Furthermore, hypertension can exacerbate swelling and is a contributing risk factor for kidney disease.7 Swelling around the eye may also occur due to the protein leakage by the kidney in urine instead of keeping it in the body.5

  1. Fatigue

When kidney functions decrease severely, more impurities and toxins build up in the blood. This causes the feeling of weakness, tiredness, and inability to concentrate properly.5 Furthermore, other related conditions such as anaemia and low red blood cell count can make a patient with CKD feel tired. While the latter conditions can be treated with medication, making simple lifestyle changes that impact the severity of CKD can also improve energy levels.8

  1. Feeling Cold

Anaemia is one of the kidney disease complications. Red blood cells provide the body with the energy it needs for daily activities as they carry oxygen that the body needs from the lungs to all the body’s parts. Patients with anaemia feel cold due to the fewer number of red blood cells.9 They also may feel chilly due to low iron as a result of anaemia.10

  1. Dizziness and Trouble Concentrating

The accumulation of toxins in the body due to damaged kidneys affecting the brain can cause mental confusion as well as nausea.11,12 

  1. Shortness of Breath

Shortness of breath usually occurs when red blood cell counts fall beyond a certain point and anaemia becomes severe. It may also be a result of fluid buildup in the lungs. The best way to address this CKD symptom is with medication.13,14 

  1. Back Pain

Pain in the lower back where the kidney is found on either side is common with kidney diseases like infections and kidney stones. These diseases may lead to kidney blockage. Back pain due to kidney disease is sharp and constant.14 It is important to discuss pain management with your GP because many over-the-counter medications are not suitable for those with kidney disease. 

  1. Rashes

A rash happens as a result of waste accumulation in the body. Extremely itchy bumps, Small, and dome-shaped rash occurs in people with end-stage kidney disease. These bumps join together and form raised and rough patches.15 

  1. Metallic Taste in the Mouth

When kidney function is impaired, waste builds up in the body, this is named uraemia. This is the primary reason for bad breath or a metallic-like taste in the mouth, often referred to as “ammonia breath”.kidney dysfunction and waste accumulation may also alter normal zinc levels in the blood which may also increase the metallic taste. Metallic taste increase with the disease progression.16,17

  1. Nausea and Vomiting

Nausea and vomiting are common symptoms of patients due to many causes such as uremic toxins accumulation, ulcers, medications, gallbladder diseases, and many more causes. Discussing these symptoms with your doctor is vital.18 

Your kidneys and your tongue

Renal disease can affect your tongue in several ways. The most common mouth-related symptoms include dry mouth, metallic taste, gum bleeding, swollen salivary glands, and increased tartar accumulation on teeth. These symptoms are a result of the toxic buildup of waste that occurs when kidneys are unable to properly filter the blood. Furthermore, anaemia also contributes to gum disease and tooth decay in patients with CKD, increasing their risk of infection. Mouth-related issues experienced by sufferers of kidney disease may also be related to other co-occurring health conditions, such as diabetes and hypertension.19,20 In order to address these problems, it is important to speak with your doctor as well as your dentist. Inform your oral hygienist about your health record, who can help reduce pain during regular visits and provide recommendations for breath improvement, tooth appearance, and gum health. 

Tongue problems associated with CKD

A toxin called urea is normally filtered out of the bloodstream by the kidneys and passed out of the body as urine. However, when the kidneys are damaged, the body will find other ways to expel urea, usually through the breath.16 The urea being exhaled then reacts with saliva, creating ammonia. This occurrence is what leads to “ammonia breath”, a common symptom of CKD, often accompanied by a metallic taste on the tongue. Additionally, your tongue may be more likely to bleed or be painful due to the buildup of toxins associated with CKD. Especially as immune function declines, these symptoms may increase your risk of developing infections.21 Keeping your mouth healthy through regular brushing, flossing, and dental visits will reduce the impact of tongue-related kidney disease symptoms. 

Is ammonia breath a symptom of CKD?

While ammonia breath is a common symptom of CKD, it can also be caused by other conditions both related and unrelated to kidney disease. Some of the most common sources of ammonia breath include heavy alcohol use, overeating protein, urinary tract infections, dehydration, and underlying infections.16 

When to see your doctor

If you’re experiencing any symptoms of CKD, you should speak to your doctor as soon as possible. Once kidney disease has reached a certain stage, the only treatment option is an organ transplant, although life can be prolonged through dialysis.19 However, if caught early, kidney disease can be managed through dietary restrictions, medications, and other non-serious treatments.22 Being proactive about your health and honest with your doctor about symptoms can help make a life with CKD manageable, happy and fulfilling.


Kidneys are organs that filter wastes and extra water out of the body in order to produce urine and blood. Kidney disease means that the kidneys are damaged and not working properly. There are signs of kidney problems such as swelling, frequent urination, foamy urination, fatigue, dizziness, loss of concentration, nausea, feeling cold, rash, back pain, and a metallic taste in the mouth. Kidney failure can be treated by kidney transplant. However, kidney disease can be managed by non-serious treatments if caught early.


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  3. High blood pressure & kidney disease | niddk [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. [cited 2022 Dec 17]. Available from: 
  4. Heart disease & kidney disease | niddk [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. [cited 2022 Dec 17]. Available from: 
  5. 10 signs you may have kidney disease [Internet]. National Kidney Foundation. 2020 [cited 2022 Dec 18]. Available from: 
  6. Nephrotic syndrome [Internet]. 2019 [cited 2022 Dec 18]. Available from: 
  7. Handling kidney disease swelling [Internet]. Fresenius Kidney Care. [cited 2022 Dec 18]. Available from: 
  8. Anemia in chronic kidney disease | niddk [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. [cited 2022 Dec 18]. Available from: 
  9. Top 5 jobs kidneys do [Internet]. National Kidney Foundation. 2015 [cited 2022 Dec 19]. Available from:
  10. Why is it cold at dialysis centers? [Internet]. [cited 2022 Dec 19]. Available from: 
  11. Pang H, Kumar S, Ely EW, Gezalian MM, Lahiri S. Acute kidney injury-associated delirium: a review of clinical and pathophysiological mechanisms. Critical Care [Internet]. 2022 Aug 27 [cited 2022 Dec 19];26(1):258. Available from:
  12. MS SE. 15 symptoms of kidney failure [Internet]. [cited 2022 Dec 19]. Available from: 
  13. Anemia and chronic kidney disease [Internet]. National Kidney Foundation. 2015 [cited 2022 Dec 19]. Available from: 
  14. Chronic kidney disease symptoms [Internet]. Fresenius Kidney Care. [cited 2022 Dec 19]. Available from: 
  15. Kidney disease: 11 ways it can affect your skin [Internet]. [cited 2022 Dec 19]. Available from: 
  16. Ammonia breath and ckd [Internet]. Fresenius Kidney Care. [cited 2022 Dec 19]. Available from: 
  17. Experiencing metallic taste from kidney disease | metaqil [Internet]. 2022 [cited 2022 Dec 19]. Available from: 
  18. What causes nausea/vomiting in kidney patients and how can it be relieved? [Internet]. National Kidney Foundation. 2013 [cited 2022 Dec 19]. Available from: 
  19. Your kidneys and your mouth [Internet]. [cited 2022 Dec 19]. Available from:
  20. Oyetola EO, Owotade FJ, Agbelusi GA, Fatusi OA, Sanusi AA. Oral findings in chronic kidney disease: implications for management in developing countries. BMC Oral Health [Internet]. 2015 Feb 20 [cited 2022 Dec 19];15:24. Available from: 
  21. Gupta M, Gupta M, Abhishek. Oral conditions in renal disorders and treatment considerations – A review for pediatric dentist. The Saudi Dental Journal [Internet]. 2015 Jul 1 [cited 2022 Dec 19];27(3):113–9. Available from: 
  22. Managing chronic kidney disease | niddk [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. [cited 2022 Dec 19]. Available from: 
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Kristen Bowles

Masters of Science - MSc Epidemiology Student, London School of Hygiene and Tropical Medicine, England
Kristen graduated as Summa Cum Laude and is now pursuing Masters of Epidemiology in LSHTM.
Experienced in cultural anthropology from the University of St. Andrews, and hopes to continue working in Europe with a special focus on medical mistrust and how these social factors influence health data, equity, and disease spread.

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