Complications of uremia2017-01-24 14:37
Complications of uremia
Uremia is a general term for a series of symptoms occurred in advanced renal failure, chronic renal failure is mainly reflected in the accumulation of harmful substances caused by poisoning and kidney hormones and reduce the incidence of anemia is the most common bone disease, early nausea, anorexia and vomiting and other gastrointestinal symptoms, into the late stage of uremia, systemic will the involvement of heart failure, psychosis, coma and other serious, life-threatening, past that uremia is incurable, since this century in 0s to carry out the method of dialysis and renal transplantation surgery, the uremic patients to prolong life.
In uremia, in addition to the above water, electrolyte, acid-base balance disorders, anemia, bleeding tendency, hypertension aggravated, clinical manifestations can also occur in the organ system dysfunction and metabolic disorders caused by, as follows.
(a) nervous system symptoms
Nervous system symptoms are the main symptoms of uremia, in the early stage of uremia, patients often have dizziness, headache, fatigue, comprehension and memory loss and other symptoms, with the aggravation of the disease can appear irritability, muscle tremors, convulsions; finally to apathy, lethargy and coma, these symptoms are related to the following factor:
Accumulation of certain toxic substances may cause degeneration of nerve cells;
Electrolyte and acid-base disturbance;
Cerebral vasospasm, hypoxia and capillary permeability induced by renal hypertension can cause degeneration of brain cells and brain edema.
(two) the symptoms of digestive system
The earliest symptom of digestive system in patients with uremia is loss of appetite or anorexia, indigestion; illness can be nausea, vomiting or diarrhea, these symptoms may occur in the gut bacteria and urease urea decomposed into ammonia, ammonia stimulation gastric intestinal mucosa caused by inflammation and multiple superficial ulcer patients. Often associated with gastrointestinal bleeding, nausea and vomiting in addition, but also with the central nervous system dysfunction.
(three) cardiovascular system symptoms
Chronic renal failure due to renal hypertension, acidosis, hyperkalemia, sodium and water retention, anemia and toxic substances etc., can occur heart failure, arrhythmia and myocardial damage, because urea (possibly uric acid) stimulation effect, can also have sterile pericarditis, patients with precordial pain; physical examination time and pericardial rub, severe pericardial cavity in cellulose and bloody exudate appeared.
(four) respiratory symptoms
Slow respiratory acidosis and deep, serious when can see the particularity of Kussmaul respiratory acidosis, the patients breath Hugh urine taste, this is because the bacteria in liquid ammonia urea formation sleep because of severe patients had pulmonary edema, fibrinous pleurisy or calcification of lung disease, pulmonary edema and heart failure, hypoproteinemia, the sodium and water retention factors of cellulose pleurisy is urea stimulation induced inflammation; pulmonary calcification is caused by calcium phosphate deposition in lung tissue.
(five) skin symptoms
Itchy skin is a common symptom in patients with uremia, may be toxic products of receptors in the skin irritation caused by; others think that with secondary hyperparathyroidism, because after parathyroidectomy, the symptoms of pain, immediately lift in patients with dry skin, desquamation and yellowish brown, skin color change that is, before the urinary pigment increased the absorption spectrophotometer. But, that is mainly the skin pigment melanin in the exposed parts of the skin, slight contusion can cause skin ecchymosis, because sweat contains high concentration of urea, thus opening a white crystalline urea in the sweat glands, called urea cream.
(six) substance metabolism disorder
To reduce the sugar tolerance decreased in uremic patients was 1 glucose, the glucose tolerance curve with mild diabetes is similar, but this change is not sensitive to exogenous insulin, causing mechanism of impaired glucose tolerance may be:
Decreased insulin secretion;
Because of the increase of the basal level of growth hormone secretion, the role of insulin is strengthened;
Insulin binding to the target cell receptor, the role of insulin has weakened;
The related liver glycogen synthase activity reduced disorders caused hepatic glycogen synthesis, now that the main reason causing the above changes may be the toxic effect of urea, creatinine and molecular weight of poison.
2 negative nitrogen balance negative nitrogen balance can cause patient weight loss, cachexia and hypoalbuminemia, hypoalbuminemia is one of the important causes of renal edema caused by factors, the negative nitrogen balance:
The patient intake of protein restricted or because of anorexia, nausea and vomiting caused by reduced protein intake;
Some substances such as methyl guanidine can enhance the catabolism of tissue proteins;
The combination of infection can lead to protein degradation;
The result of protein loss due to hemorrhage;
With the loss of a certain amount of urinary protein.
When a large number of uremia by blood urea into the intestinal lumen, intestinal bacteria of the urea decomposition of ammonia, ammonia is transported to the liver blood, and synthesis of urea, it can synthesize non essential amino acid, which is beneficial to the body, so some people think that uremia protein intake may be less than normal people, even less than 20g per day to maintain nitrogen balance, but must be given a higher nutritional value of protein, which contains essential nutrients rich in amino acid, some people think that in recent years.
In order to maintain the balance of nitrogen in patients with uremia, protein intake should not be significantly different from that of normal subjects