2014年12月27日星期六

Clinical manifestations of chronic renal failure

1. Digestive System

It is the symptom of early and frequent.

(1) Anorexia (loss of appetite often appeared before).

(2) Nausea, vomiting, bloating.

(3) The tongue and mouth ulcers.

(4) The smell of ammonia in oral.

(5) upper gastrointestinal bleeding.

2. Blood System

(1) anemia: It is symptoms of uremia patients. The degree of anemia in parallel with the degree of uremia, erythropoietin (EPO) is mainly due to the reduction.

(2) Tendency to bleeding: can be expressed as skin, mucous membrane bleeding ect, and increased platelet destruction, prolonged bleeding etc, which can be caused by toxins, correctable dialysis.

(3) abnormal white blood cells, leukopenia, chemotaxis, phagocytosis and bactericidal capacity and prone to infection, dialysis can improve.

3. Cardiovascular System

It is most common cause of death from renal failure

(1) Hypertension: The majority of patients (80%) have different degrees of high blood pressure, can cause atherosclerosis, left ventricular hypertrophy, heart failure.

(2) Heart failure: They often appear cardiomyopathy performance by sodium retention, hypertension, uremic cardiomyopathy caused.

(3) Pericarditis: inadequate dialysis urea or disease due mainly blood, usually late performance.

(4) The atherosclerosis and vascular calcification: Proceed quickly, hemodialysis is more evident, coronary, cerebral artery, peripheral systemic artery may occur, especially hyperlipidemia and hypertension due.

4. Nervous and muscular systems

(1) Early stage: Fatigue, insomnia, lack of concentration etc.

(2) Subsequently period: Peripheral neuropathy, sensory nerve that represents a significant move.

(3) dialysis disequilibrium syndrome: With dialysis-related, often occurs in the initial dialysis patients. Reduce excess blood urea nitrogen, intracellular osmotic imbalance, causing increased intracranial pressure and cerebral edema caused by performance nausea, vomiting, headache, severe convulsions.

5. Renal osteodystrophy

It refers in general bone changes when uremic. Hypocalcemia, hyperphosphatemia, the active vitamin D deficiency can be induced secondary hyperparathyroidism. The variety of factors that lead to renal osteodystrophy (ie osteodystrophy, renal) include fibrocystic osteitis (high turnover bone disease), osteomalacia (bone disease low turnover), bone formation and mixed osteodystrophy. Renal osteodystrophy clinically manifested as:

(1) can cause spontaneous fractures

(2) The symptoms are uncommon as bone pain, difficulty walking etc.

6. Respiratory system

(1) When acidosis, respiratory are deep and long.

(2) uremic bronchitis, pneumonia (butterfly wings), pleurisy etc.

7. Skin symptoms

Itching skin, deposition of urea cream, face uremia, dialysis does not improve.

8. Endocrine dysfunction

Main manifestations are

(1) Endocrine dysfunction own kidney: By implementing 1,25 (OH) D3 2vitamina, erythropoietin deficiency and renal renin - angiotensin Ⅱ excessive.

(2) external endocrine dysfunction: The majority of patients had secondary hyperparathyroidism (elevated serum PTH), insulin receptor disorders, as elevated glucagon ect. About 1/4 of patients with mild decrease levels of thyroid hormone. Some patients may experience hypogonadism, manifested as disorders of gonadal maturation or atrophy, decreased libido, amenorrhea, infertility etc., can be associated with levels of abnormal serum sex hormones and other factors.

9. With a serious infection

Easy to infection, pulmonary infection is more common. When fever infection, it may be normally not evident.

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