Diagnosis of chronic renal failure

Slow early renal failure, in addition to the quality of nitrogen sanguine disease, but often no clinical symptoms, but only showed symptoms of the underlying disease, the progression of the disease to residual renal unit can not be adjusted to adapt to the body's minimum requirements will gradually show symptoms of uremia come out. Mainly as metabolites retention, water, electrolyte and acid-base balance and various system involvement. details as follows:

(1) water, electrolyte and acid-base balance as follows: ① sodium and water balance disorders: When excessive intake amount of sodium and water, causing fluid overload, edema, hypertension and heart failure, appears dilution of sodium hyperlipidemia. Slow renal failure rarely hypernatremia. When fluid loss (vomiting, diarrhea), prone to hypovolemia, leading to orthostatic hypotension and cited the residual renal function deterioration. ② potassium imbalance: uremia have a tendency hyperkalemia, acidosis, transfusion of banked blood potassium intake or excessive use of potassium-sparing diuretics may aggravate hyperkalemia. Hyperkalemia can cause severe arrhythmia or cardiac arrest, some patients have muscle weakness or paralysis. ECG monitoring for hyperkalemia fast and accurate, showed T wave height and sharp, P? R interval prolongation and QRS wave widened. Slow hypokalemia when renal failure is rare, occurring mainly in the underlying disease is renal tubular? Interstitial diseases. ③ acidosis: acidic substances due to renal excretion barriers to retention of uremic acidosis is the most common cause of death. ④ hypocalcemia and hyperphosphatemia: hypocalcemia symptoms generally do not appear when the use of basic drugs to correct acid poisoning, caused by the reduced free calcium tetany. Hyperphosphatemia and hypocalcemia can cause secondary hyperparathyroidism, causing bone demineralization (osteoporosis), osteomalacia, osteitis go far renal osteodystrophy. ⑤ hypermagnesemia: reduction caused by renal excretion of magnesium.

(2) The system symptoms ① cardiovascular and pulmonary symptoms: hypertension, heart failure (which is a common cause of death), pericarditis, atherosclerosis (coronary heart disease is the leading cause of death), uremia pneumonia, bronchitis and pleurisy. ② blood system: anemia, bleeding tendencies and abnormal white blood cells. ③ nerve, muscle symptoms: fatigue, insomnia, lack of concentration is one of the early symptoms of slow renal failure. ④ gastrointestinal symptoms: loss of appetite to slow the earliest and most common symptom of kidney failure. ⑤ skin symptoms: itching is a common symptom. ⑥ renal osteodystrophy. ⑦ endocrine disorders. ⑧ easy to concurrent infections: one of the main causes of death. ⑨ metabolic disorders: hypothermia, abnormal glucose metabolism, hyperuricemia, dyslipidemia.


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