Muscular and Articular System



Generalized malaise, muscle fatigue, weakness, and twitching may be seen in patients with ESRD. A proximal myopathy, perhaps related to hyper­parathyroidism, may occur. The fasciculation and twitching of muscles may be related to depolari­zation of muscle cells secondary to uremia.

Articular symptoms, including overt arthritis, occur in uremic individuals. Although any form of arthritis may occur, pseudogout due to the de­position of calcium pyrophosphate seems to occur with increased frequency in patients with renal disease. Interestingly, despite the presence of hy­peruricemia, overt attacks of gout are rare.