Serious renal failure may cause no symptoms at all! This is why we do U&Es before surgery and other major interventions. The silence of renal disease creeps up on us (doctors and patients) with uncanny stealth which is as alarming as the image in ”˜Silence’, by Tiago Phelipe. Microalbuminuria is a famously silent harbinger of serious renal and cardiovascular risk. In one study, 30% of those with type 2 diabetes mellitus died within ~5 years of developing microalbuminuria. This picture serves to remind us not to dismiss old chronic symptoms such as fatigue or ”˜not being quite with it’ without doing a blood test. Literature: ’Oxford Handbook of Clinical Medicine’ (8th edition).