-IBIS-1.5.0-
tx
urinary system
kidney failure: chronic
diagnoses
definition and etiology
definition:
A disorder of the kidneys resulting from many pathologic conditions that cause abnormal and insufficient functioning and excretion of the kidneys.
etiology:
There are 3 stages of chronic kidney failure (CKF): decreased renal reserve, renal failure, and uremia. The most common cause for CKF is glomerulonephritis, but other frequently seen precipitating factors are diabetes mellitus, polycystic kidney disease, hypertension, nephrosclerosis, as well as assorted other reasons. The glomerular filtration rate must be significantly reduced before symptoms of CKF appear.
In the early stages of CKF, when the GFR is only 35-50% of normal, the patient is totally asymptomatic, and due to renal functional adaptation, the renal indices are well maintained.
When the GFR reaches 20-35% of normal azotemia will begin, and although patients are still usually pretty symptom-free, the renal reserve is compromised to the point that any additional stress (infection, dehydration) can usher in overt failure.
Overt CKF: with the systemic manifestations of uremia: is typically seen when the GFR decreases to below 20-25% of normal (GFR < 6 ml/min./sq. m).
signs and symptoms
signs and symptoms:
Patients may be asymptomatic, or may experience only mild and vague symptoms even when the BUN and creatinine are elevated.
Nocturia.
Fatigue.
Lethargy.
Diminished mental sharpness.
Neuromuscular presentations: muscle twitching/cramps, convulsions.
GI presentations: anorexia, vomiting, stomatitis, offensive taste in the mouth.
GI ulcers and bleeding: in advanced stages.
Malnutrition with muscle wasting: in advanced disease.
Skin: may become yellow-brown, itching may be severe, may develop a "uremic frost" (urea from the sweat crystallizing on the skin).
Hypertension.
Many other signs and symptoms ranging from sexual dysfunction, to headache, to ecchymoses, to hepatitis, etc.
lab findings:
Increased BUN and creatinine.
Acidosis.
Normochromic normocytic anemia.
Loss of renal concentrating ability specific gravity usually equals glomerular filtrate (<1.020).
Decreased urine osmolality.
Decreased urine volume in dilution test.
Abnormal U/A: proteinuria, hematuria, pyuria, casts.
Decreased serum sodium.
Increased serum potassium.
Decreased serum calcium.
Increased serum phosphorus: when the creatinine clearance falls below 25 ml/minute.
Increased or normal serum alkaline phosphatase.
Increased serum magnesium when GFR falls below 30 ml/minute.
Increased serum amylase.
Possible increase in serum CK.
Increased serum triglycerides, VLDL and cholesterol.
Increase in blood organic acids: phenol, indoles, amino acids.
(+) bleeding tendency.
Decreased serum albumin and total protein.
May see lab findings in regard to uremic meningitis or uremic pericarditis/pleuritis/pancreatitis, or other disorders.
course and prognosis
Prognosis depends on the cause and severity of the primary disease, and existing complications. Close attention to diet and protein/potassium/ liquid intake, dialysis or transplantation are the conventional treatments.
differential diagnosis
Determine underlying cause.
Hepatic or cardiac failure.
CNS infections.
footnotes