The clinical manifestations of chronic renal failure patients
1. Water, electrolyte and acid-base balance of the performance of
(1) excessive water loss or water: normal kidney can be carried out on the water metabolism in a larger range of adjustment. Renal failure due to concentration dysfunction, nocturia, polyuria, coupled with loss of appetite, vomiting, diarrhea, easy to cause water loss, due to poor renal drainage, the water or rehydration inappropriate prone to water retention, manifested as edema, hypertension , heart failure, or even pulmonary edema, cerebral edema and other serious consequences.
(2) low-sodium and high hypernatremia: Due to vomiting, diarrhea, loss of too much sodium, renal tubular reabsorption of sodium reduction prone to hyponatremia, manifested as fatigue, loss of appetite. In severe cases, hypotension and even coma. If a sudden increase in sodium intake, the easy case of water, sodium retention, high blood pressure, edema and heart failure.
(3) potassium and hypokalemia: oliguric renal failure to reduce potassium excretion. Increase in body catabolism, metabolic acidosis, the extracellular K + to the transfer, use retention potassium-sparing diuretics, or angiotensin-converting enzyme inhibitors and so on, can lead to serious hyperkalemia. Manifested as drowsiness, severe arrhythmia, or even cardiac arrest. If you eat small, insufficient intake of potassium, nausea. Vomiting, diarrhea and long-term use of diuretics, potassium row. Prone to hypokalemia. Manifested as fatigue, weakness, abdominal distension, limb paralysis. In severe cases, serious arrhythmias and respiratory muscle paralysis.
(4), hypocalcemia and hyperphosphatemia: renal failure when the kidney can not produce active vitamin D3, reducing the absorption of calcium from the intestine, which occurs hypocalcemia. Rarely symptoms. Only in correcting acidosis with sodium bicarbonate may reduce the free calcium and stimulation of hand, foot and convulsions. Nephron appears to reduce phosphorus excretion hyperphosphatemia. Hyperphosphatemia can increase blood calcium and phosphorus product. Hypocalcemia to increase PTH secretion, prone to renal osteodystrophy, metastatic calcification and so on.
(5), hypermagnesemia: renal failure due to renal magnesium row reduced, while the intestinal absorption of magnesium is still normal. Be caused by hypermagnesemia. Manifested as fatigue, skin flushing, burning sensation and so on. Severe hypermagnesemia may occur paralysis and other serious respiratory and cardiac symptoms.
(6), metabolic acidosis: Chronic renal failure caused due to the following reasons metabolic acidosis;
① renal failure metabolites, such as phosphoric acid, sulfuric acid and acetyl-acetic acid and other acid excretion due to renal retention barriers;
② tubular hydrogen ion secretion functional damages caused by hydrogen reduction in sodium ion exchange, thereby hydrogen retention and reabsorption of sodium bicarbonate can not be lost from the urine;
③ tubular cell manufacturing capacity to reduce ammonia, uric acid-based dysfunction, alkali salts can not be retained. Mild metabolic acidosis usually no clinical symptoms, severe acidosis significant drop in blood PH, anion gap was significantly higher than normal, the patient had fatigue, anorexia, nausea, vomiting, abdominal pain, headache, irritability, emergence of deep and long breath. Severe cases may coma, heart failure, blood pressure fall and cardiac arrest.
2. Acidosis: Acid poisoning is common with chronic renal failure symptoms, when the blood creatinine clearance rate dropped to a normal 1 / 5, will not be able to maintain normal balance. Clinically manifested as fatigue, nausea, vomiting, irritability, drowsiness, chest tightness, deep breathing, which may eventually died of respiratory paralysis and shock.
3. Digestive system due to an increase of urea excluded from the intestinal system, intestinal bacterial enzymes break down urea to ammonia, causing digestive dysfunction. That this disease first appeared in the prominent and the most common symptoms are aggravated with the disease progression. Gastrointestinal tract symptoms are mainly urea increased, from bacteria break down into ammonia and ammonium carbonate to stimulate the gastrointestinal tract mucosa caused by, but also with increased levels of gastrointestinal peptide hormones and metabolic disorder caused by a mechanism to reduce the mucosal barrier. The early stage loss of appetite, bloating, and nausea, vomiting, hiccups and diarrhea.
4. Respiratory metabolic acidosis often have shortness of breath. Or even Kussmaul breathing. Metabolite retention and immune function in the lower respiratory tract infection easy to merge can be expressed as bronchitis, pneumonia, pleurisy combined pleural effusion. Interstitial pneumonia is more common, X-ray examination showed typical of those on both sides of butterfly-shaped hilar shadow, known as the "uremic lung."
5. The circulatory system blood pressure is very common, to a degree varying severity, the general increase in both systolic and diastolic blood pressure, severe cases, hypertensive encephalopathy occurred. Uremic pericarditis occurs when serious symptoms, known as uremic pericarditis, left-onset often have severe chest pain, often pericardial friction sound, severe cardiac tamponade may occur, the exact cause remains unclear, in part related to uremia toxin. Uremic cardiomyopathy often occurs in patients with advanced, its mechanism and anemia, hypertension, volume overload, hypoxia, acidosis, electrolyte metabolism disorder, energy metabolism, parathyroid hormone and middle molecular substances such as myocardial toxins related to multiple clinical manifestations of cardiac expansion, various arrhythmias and congestive heart failure. Heart failure is a common cause of death in uremic capacity overload is the most common factors, in addition to hypertension, cardiomyopathy, cardiac arrhythmia, severe anemia and other relevant. In patients with chronic renal failure due to lipid metabolic disorders, atherosclerosis, ischemic heart disease incidence has also increased.
6. The nervous system with chronic renal failure because of various kinds of psychiatric symptoms caused by a combination of factors. Disturbance of consciousness, seizures, flapping tremor, myoclonus. Peripheral neuropathy, such as "restless legs", ant-line flu, autonomic symptoms and uremic encephalopathy, thought is not concentrated, insomnia or drowsiness, convulsions and seizures late stage. EEG abnormalities, increased protein in cerebrospinal fluid. In short as the deterioration of renal function occurs more signs.
7. Hemopoietic system when the serum creatinine is greater than 309.4μmoL / L, the vast majority of patients develop anemia, usually a normal form, are pigmented anemia. And with the renal function into - further exacerbated by diminished. Main reasons for renal anemia and renal secretion of erythropoietin (EPO) to reduce blood present in the material inhibiting erythropoietin, red blood cells shorten the life span of hematopoietic deficiencies (iron and folic acid deficiency), aluminum poisoning, and other relevant secondary infection. Bleeding is also very common, manifested as subcutaneous bleeding, epistaxis, menorrhagia and gastrointestinal bleeding. Bleeding tendency and bleeding time prolonged, increased platelet destruction and dysfunction, and a variety of coagulation factor function abnormalities. White blood cell count were normal, some patients may have reduced granulocyte cells or lymphocytes.
8. Uremic myopathy skeletal system in order to proximal muscle involvement common. Renal osteodystrophy very common, referred to renal osteodystrophy, including renal rickets, renal bone softening disease, osteitis fibrosa, osteoporosis, bone sclerosis, metastatic calcification of a variety of performance. Clinical symptoms of bone small, a few expressed as bone pain, walking inconvenience.
9. Cutaneous manifestations in patients with facial chlorosis, unlucky stagnation, a sense of mild edema, expressed as uremia face. Dry skin, scaling, matt, pigmentation. Refractory skin itching common calcium salts and urea cream and other relevant calm. Occasional petechiae, itching, and resistance due to reduction of skin prone to cause purulent infection.
10. Immunocompromised reduce the number of peripheral blood lymphocytes, a variety of lymphocyte subsets distribution and dysfunction. Produce enough immune globulin, immune dysfunction, easily combined with respiratory, urinary and skin infections, easy to develop into septicemia.
11. Gonadal dysfunction in chronic renal failure can occur when the endocrine disorder, the renin - angiotensin, prolactin and gastrin secretion of excess thyroid stimulating hormone, testosterone, cortisol lower than normal, thyroid, gonadal function is low, males were found to lack of sexual desire and impotence, women with advanced renal failure can occur amenorrhea, infertility. Insulin, glucagon and parathyroid hormone such as its role in renal failure may be extended.
12. Metabolic abnormalities, low levels of essential amino acids, fasting blood glucose normal or low, often impaired glucose tolerance, triglyceride levels are often elevated, very low and low-density lipoprotein also increased.
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