The Uruguayan coast of the Río de la Plata river estuary (RdlP) is 300 km long. It encompasses an inner tidal river and a middle and an outer estuary. The RdlP is a micro-tidal system dominated by river inflow from the Paraná and Uruguay rivers and southern winds with increasingly frequent wind-induced storm surges impacting the coast. The El Niño-Southern Oscillation influences the river inflow, prevailing winds, water/sea level and beach erosion. First, we focus on the IPCC Reasons for Concern (RFC) about the trends of climate risks threatening the Uruguayan coast. The trends and maxima of air temperature, water/sea levels and river inflow in three coastal stations from 1980 to 2019 show temporal changes attributable to climate change and El Niño-Southern Oscillation (ENSO). The occurrence, evolution and Montecarlo simulations of return periods of the yearly river flow and sea level height maxima provide metrics of RFC to categorise the climate risks from past to projected future and the level of risk from undetectable to very high. Then, we summarise some current and expected climate risks and present the current adaptation framework and some expected impacts. The RFC has increased, reaching moderate to high-risk levels.