Chronic kidney disease presenting acutely is not uncommon, often avoidable and associated with adverse outcomes. In the early stages of chronic kidney disease, there may be no symptoms. However, when kidney function is less than one-tenth of normal, the symptoms may arise. The patients in end-stage renal disease may also present with nonspecific symptoms. A 46 year old man admitted to our hospital with knee pain. He had no other complaints. His blood urea and creatinin levels were 232 mg/dl and 19.5 mg/dl respectively. He was anemic and venous blood gas revealed pH: 7.10, HCO3-: 10 mEq/L. But his physical examination was normal. The glomerular filtration rate was greatly reduced, altough his blood pressure was within normal limits. Hemodialysis had been initiated immediately and within 24 hours blood urea nitrogen had decreased to 145 mg/dl. The clinicians must be aware of non-spesific symptoms such as arthralgia, which should masquerade the underlying chronic kidney disease. The identification, follow-up and appropriate referral of patients with raised serum creatinine is likely to reduce its incidence.