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Clinical manifestations of chronic renal failure


At different stages of CRF, the clinical manifestations are also different. In CRF the compensation period and decompensation early, the patient can not have any symptoms, or only weak, backache, nocturia and other mild discomfort; a minority of patients with anorexia, metabolic acidosis and mild anemia. CRF metaphase, these symptoms become more obvious. In uremia, acute heart failure, severe hyperkalemia, gastrointestinal bleeding, central nervous system disorders and other serious complications, and even life-threatening.
1 water and electrolyte metabolism disorder of chronic renal failure, acid-base imbalance and a variety of electrolyte metabolism disorders are common. In this kind of metabolic disorders, metabolic acidosis and sodium and water balance disorders are the most common.
(1) metabolic acidosis in mild to moderate chronic renal failure (GFR>25 ml/min or <350 mol/l, serum creatinine) patients, some patients due to the hydrogen ion barrier tubular secretion or renal tubular reabsorption of HCO3 - decreased, thus the normal anion gap hyperchloremic metabolic acidosis. The renal tubular acidosis. When the GFR is reduced to <25 (ml/min >350 mol/l, serum creatinine, renal failure) metabolites such as phosphoric acid, sulfuric acid and other acidic substances due to renal excretion disorder and retention can occur hyperchloraemia of (or chloremia of) high anion gap metabolic acidosis, namely uremia acidosis". Mild chronic acidosis, but most patients have few symptoms, such as arterial blood HCO -3 < 15 mmol/L, can appear obvious loss of appetite, vomiting, weakness, deep breathing etc..
(2) the disorder of water and sodium metabolism: the main manifestations of water sodium retention, or low blood volume and hyponatremia. When the renal function is not complete, the kidney is too much or too much capacity, the ability to adapt to the gradual decline. The retention of sodium and water can be manifested as different degrees of subcutaneous edema or / and effusion, which is common in clinical practice. Low blood volume mainly manifested as hypotension and dehydration. Causes of hyponatremia, which can cause the lack of sodium (true hyponatremia), but also because of too much water or other factors caused (hypokalemia), while the latter is more common.
(3) potassium disorders: when GFR was reduced to 20-25ml/min or less, the renal excretion of potassium capacity decreased gradually, then prone to hyperkalemia; especially when excessive intake of potassium, acidosis, infection, trauma, such as gastrointestinal bleeding occurs, more prone to hyperkalemia. Severe hyperkalemia (serum potassium >6.5mmol/l) has a certain risk, the need for timely treatment and rescue. At the same time, due to lack of potassium intake, too much loss of gastrointestinal tract, the use of potassium excretion and other factors, there may be hypokalemia.
(4) disturbance of calcium and phosphorus metabolism: phosphorus and calcium deficiency. The lack of a variety of factors and calcium activated calcium intake, vitamin D deficiency, hyperphosphatemia, metabolic acidosis and so on, there was lack of calcium hypocalcemia. The concentration of serum phosphorus was regulated by the absorption of phosphorus by the intestinal tract and the excretion of the kidney. When the glomerular filtration rate decreased and the urine excretion decreased, the serum phosphorus concentration increased. In early renal failure, serum calcium, phosphorus can be maintained in the normal range, and usually do not cause clinical symptoms, only in the middle and late stage of renal failure (GFR<20ml/min) occurs when hyperphosphatemia, hypocalcemia. Hypocalcemia, blood disease, high phosphorus w activity of vitamin D deficiency can cause elevated parathyroid hormone (PTH), namely, secondary hyperparathyroidism (PHPT) and renal osteodystrophy.
(5) disturbance of magnesium metabolism: when GFR<20ml/min, due to the reduction of renal excretion of magnesium, often mild mild magnesium. Patients often have no symptoms; such as the use of magnesium containing drugs (antacids, laxatives, etc.) are more likely to happen. Magnesium deficiency can also occur, associated with inadequate intake of magnesium or excessive use of diuretics. 2 protein, carbohydrate, fat and vitamin metabolism disorders
The protein metabolism disorder of CRF patients is generally manifested as the accumulation of protein metabolites (including the level of serum albumin), the decrease of serum albumin and the level of essential amino acids. These disorders were mainly related to the increase of protein decomposition or / and the decrease of synthesis, the negative nitrogen balance, and the disturbance of renal excretion. Abnormal glucose metabolism is mainly manifested in two cases of impaired glucose tolerance and hypoglycemia. Hyperlipidemia is very common, most of the patients showed mild to moderate high glycerol three hyperlipidemia, a small number of patients with mild hypercholesterolemia, or both of the two. Vitamin metabolism disorders are common, such as increased serum vitamin A levels, vitamin B6 and folic acid deficiency.
3 cardiovascular performance
Cardiovascular disease is one of the major complications and the most common cause of death in patients with CKD. Especially in the stage of end-stage renal disease, the mortality rate was further increased (45%-60%). A recent study found that uremic patients with adverse cardiovascular events and atherosclerotic cardiovascular disease than the general population is about 15-20 times.
The more common cardiovascular disease include hypertension and left ventricular hypertrophy, heart failure, uremic cardiomyopathy, pericarditis, pericardial effusion, vascular calcification and atherosclerosis. In recent years, it has been found that vascular calcification, which is caused by hyperphosphatemia, abnormal calcium distribution and the lack of "vascular protective protein" (such as A), plays an important role in cardiovascular disease

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