Clinical Significance Of The Pathogenesis And Systemic Symptomatology Of Chronic Renal Failure

Funom Makama By Funom Makama, 6th Feb 2014 | Follow this author | RSS Feed | Short URL http://nut.bz/2yly0hr5/
Posted in Wikinut>Health>General Health>Diseases & Infections

Chronic Renal failure is an irreversible ailment which only needs management till the life of such a patient reaches terminal stage. Knowing the major or most significant symptoms will help both the physician and the patient in the direction of treatment. Sorry for the so many technical (medical) grammar.

Causes And Pathogenesis

When irreversible damage to the nephrons progresses steadily, it leads to renal functional impairment. If renal failure persists for more than sex month, it is termed chronic renal failure.

Common causes
The following are common causes of this condition:

1. Chronic glomerulonephritis
2. Chronic interstitial nephritis
a. Due to infection;
b. Due to drugs, e.g. analgesic abuse
c. Polycystic disease of the kidneys;
d. Longstanding partial urinary tract obstruction
e. Bilateral ureteric obstruction
f. Lower urinary obstruction
g. Hypertension with nephrosclerosis (renovascular disease), atherosclerosis (renovascular disease), atherosclerosis, multiple emboli;
and
3. Miscellaneous
a. Diabetic nephropathy
b. Gout
c. Amyloidosis
d. Multiple myeloma
e. Radiation nephropathy and
f. Connective tissue diseases.


Pathogenesis:
Chronic renal failure is due to progressive destruction of nephrons. As the nephrones are destroyed, the parenchyma shrinks and it is replaced by fibrosis. The remaining nephrons undergo hypertrophy. This gives the appearance of a granular contracted kidney. Renal function is maintained by the hypertrophied nephrons. Since the concentrating function is impaired, adjustment of urine volume becomes defective and polyuria with urine of specific gravity around 1010 (the Sp Gr of glomerular filtrate) occurs.

The blood pressure goes up progressively and this form of secondary hypertension exerts its deleterious influence on the kidney, heart and brain. The early phases of the disease are asymptomatic since the kidney has considerable reserve function. As the renal function progressively deteriorates, the patient becomes more and more symptomatic. Symptoms and biochemical abnormalities are evident only when the renal function has deteriorated to less than 35% of the normal . When the renal function is between 35% to 25% of the normal, symptoms like pallor, tiredness and nocturia are evident. The blood urea and serum creatinine are elevated and the serum bicarbonate may be reduced slightly. This is the stage of mild renal insufficiency. Several intercurrent factors precipitate the development of advanced renal failure in them. These are dehydration and electrolyte imbalance, infection, cardiac failure, trauma, blood loss, excessive protein intake, alcoholic bouts, and the use of nephrotoxi drugs. When renal insufficiency is moderate (function falls to 25-15% of normal), symptoms like fatigue nausea, anemia, impotence, metabolic acidosis and bone pains may develop.

Symptomatology

Systemic Symptoms
1. Neurological: Fatigue, insomnia, reversal of sleep rhythm, peripheral neuropathy, muscular irritability, convulsions and coma.

2. Gastrointestinal: Anorexia, nausea, vomiting and peptic ulcer
Hematological: normocytic normochromic anemia and bleeding tendency due to platelet dysfunction.

2. Endocrine: Secondary hyperparathyroidism, amenorrhoea, infertility and impotence.

3. Dermatological: Sallow pigmentation, intractable pruritis, (Calcium deposition in the tissues, especially skin, giving rise to pruritis), exocriations and uremic frost (whitish-precipitate of urea crystals on the skin occurring in advanced uremia).

4. Skeletal: Renal osteodystrophy which includes osteomalacia, osteoporosis, osteitis fobrosa or rickets.

5. Cardiovascular: Hypertension, cardiac failure, pericarditis, myocardiopathy and accelerated atherosclerosis

6. Ocular: Red eye (due to conjunctival calcium deposition and congestion), calcium deposition in the cornea (band keratopathy) and hypertensive retinopathy.

7. Respiratory: Kussmaul’s respiration, uremic lung (increased pulmonary capillary permeability leading to transudation of fluid and radiological appearance similar to left ventricular failure).

When renal function falls below 5% of normal, the condition is termed “end-stage renal failure”. The continued survival at this stage is possible only with renal support in the form of lifelong dialysis or renal transplantation.

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Comments

author avatar Phyl Campbell
7th Feb 2014 (#)

Wow. Now this is a good article from which interested people can learn a lot! Thank you.

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author avatar Funom Makama
14th Feb 2014 (#)

Thanks Phyl Campbell......

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