In chronic renal failure, the signs and symptoms of the original kidney disease are often masked and the signs and symptoms of renal insufficiency are mainly manifested, or even the main complaint is damage to one organ of one system, such as nausea and vomiting, loss of appetite, vomiting blood, black feces, and ulcers in the stomach on gastroscopy are easily misdiagnosed as digestive system diseases. If anemia and bleeding are the main complaints, it is easy to misdiagnose as hematologic diseases. The peripheral blood picture shows complete blood cell reduction, and the bone marrow shows low proliferation of various series of bone marrow picture of aplastic anemia. If palpitations, shortness of breath, heart failure and pericarditis are the main manifestations, it is easy to misdiagnose as cardiovascular disease. When uremic lung is prominent with cough, coughing, hemoptysis, pulmonary rales, pleural friction sounds, etc., it can be misdiagnosed as respiratory disease. When decalcification, bone pain, pathological fracture are prominent manifestations, it is easy to misdiagnose as endocrine system diseases. Skin rash, itchy skin cancer, and skin urea cream can be misdiagnosed as dermatological disease. Clinicians must be alert to uremia and fully understand the complex clinical manifestations of uremia in order to make a correct diagnosis in a timely manner. Pay attention to the history of renal disease, perform routine urine examination, examination of renal function, acid-base balance examination, electrolyte examination. ultrasound CT examination should demonstrate bilateral atrophic kidneys to enable the correct diagnosis to be established very early. A history of chronic kidney disease, the presence of dysfunction of various organs of systems other than the kidneys, laboratory tests showing accumulation of metabolites in the blood, a series of electrolyte disorders, acid-base balance disorders, and endocrine disorders, can generally establish the diagnosis. After establishing the diagnosis of uremia, the diagnosis of the cause of uremia, i.e. the primary disease, should be further clarified. Ultrasound and CT examination should show atrophy of both kidneys. Radionuclide nephrography should demonstrate bilateral non-functioning kidneys. eCT should demonstrate extremely reduced renal blood flow and extremely decreased glomerular filtration rate.