Common complications of uremia

Complications of uremia

Uremia is the general term for a series of symptoms of late renal failure.

The symptoms of chronic renal failure are mainly manifested in the accumulation of harmful substances and the occurrence of anemia and osteopathy.

The most common early stages are gastrointestinal symptoms such as nausea and vomiting.

After the advanced uremia stage, the systemic system will be tired, with heart failure, mental abnormality, coma and other serious conditions, endangering life.

In the past, uremia was considered an incurable disease. Since the 1990s, dialysis methods and kidney transplantation have been carried out to significantly prolong the life span of patients with uremia.

In uremia period, in addition to the above water, electrolyte and acid-base balance disorders, anemia, bleeding tendency, the further such as high blood pressure, also can appear each organ system dysfunction and substance metabolism disorder caused by the clinical manifestation, we have points mentioned as below.

(1) neurological symptoms

The symptoms of the nervous system are the main symptoms of uremia.

In the early days of uremia, patients often have symptoms such as dizziness, headache, lack of power, understanding and memory loss.

With the aggravation of the disease can appear irritable restlessness, muscle tremor, convulsion;

Finally, it can develop into an expression of indifference, lethargy, and coma.

The occurrence of these symptoms is related to the following factors:

The accumulation of certain toxic substances may cause neuronal degeneration;

Electrolyte and acid-base balance disorders;

The cerebral vasospasm caused by renal hypertension, hypoxia and capillary permeability increase, can cause cerebral nerve cell degeneration and cerebral edema.

(2) symptoms of the digestive system

The earliest symptoms of digestive system in patients with uremia are loss of appetite or indigestion.

Anorexia, nausea, vomiting or diarrhea may occur when the condition is increased.

The occurrence of these symptoms may be broken down into ammonia by the urea enzyme of intestinal bacteria, which causes inflammation and multiple superficial small ulcers.

Patients often develop gastrointestinal bleeding.

In addition, nausea and vomiting are also associated with dysfunction of the central nervous system.

(iii) symptoms of cardiovascular system

Chronic renal failure due to renal hypertension, acidosis, hyperkalemia, sodium, water retention, anemia and toxic substances such as the role of, can occur heart failure, arrhythmia and myocardial damage, etc.

Due to the stimulation of urea (possibly uric acid), aseptic pericarditis can also occur, and the patient has the pain in the anterior region.

Smell and pericardial friction sound during physical examination.

In severe cases, cellulose and hemorrhagic exudate appear in the pericardial cavity.

(4) respiratory symptoms

In the case of acidosis, the patient was slow and deep, and the particularity of acidosis was observed in Kussmaul.

The patient's breath smells of urine, because the bacteria break down the urea in the sleeping fluid to form ammonia.

Serious patients can have pulmonary edema, fibrous pleurisy or pulmonary calcification, and pulmonary edema is related to the role of heart failure, hypoalbuminemia and sodium water retention.

Fibrous pleurisy is an inflammation caused by urea stimulation.

Pulmonary calcification is the result of calcium phosphate deposition in the lung tissue.

(5) skin symptoms

Itchy skin is a common symptom in patients with uremia. It may be caused by the irritation of the toxic product to the skin receptor.

Some people believe that a secondary parathyroid function is associated with the removal of the parathyroid gland, which can immediately relieve the painful symptoms.

In addition, the skin was dry, deformed and yellow-brown.

Changes in the color of the skin, previously thought to be the increase of the urine pigment, but the absorption spectrophotometer checked, the skin pigment is mainly melanin.

In the skin exposed area, slight contusion can cause the skin to fill the spot.

Because of the high concentration of urea in sweat, the white crystals of urea at the opening of sweat glands are called urea.

(6) material metabolism disorder

1. Reduced sugar tolerance

The glucose tolerance curve of the patients with uremia was similar to that of mild diabetics, but the changes were not sensitive to exogenous insulin.

The mechanism for reducing glucose tolerance may be:

Decreased insulin secretion;

When uremia is caused by increased secretion of growth hormone, the effect of antagonistic insulin is strengthened.

The binding of insulin and target cell receptor has weakened the effect of insulin.

The activity of liver glycogen synthase was reduced and liver glycogen synthesis was impaired.

Currently, the main causes of these changes may be the toxic effects of urea, creatinine and medium molecular weight poisons.

2. Negative nitrogen balance

The negative nitrogen balance can result in the patient's emaciation, cachexia and hypoalbuminemia.

Hypoalbuminemia is one of the most important causes of renal edema.

The factors that cause negative nitrogen balance are:

The protein intake was limited or decreased due to anorexia, nausea and vomiting.

Some substances, such as methyl guanidine, can strengthen the decomposition of histone.

When combined with infection, the protein decomposition can be enhanced.

The protein loss caused by hemorrhage;

A certain amount of protein is lost in the urine.

Urea can be infiltrated by blood into the intestines.

The intestinal bacteria can decompose the urea and release ammonia. The ammonia is transported to the liver by blood, which can be resynthesized and can synthesize non-essential amino acids, which are beneficial to the body.

So some people think that, uremia patients protein intake can be lower than normal, even less than 20 g every day to keep nitrogen balance, but must give the higher nutritional value of protein, which contains rich essential amino acids nutrition.

In recent years there have been Suggestions.

In order to maintain the nitrogen balance of patients with uremia, the protein intake should not be significantly different from that of normal people.

In addition, it is believed that the excessive restriction of protein intake in pursuit of blood urea nitrogen can make the protein consume too much and therefore be harmful to the patient.

hyperlipidemia

The main reason for the uremia is the lipoprotein (front & beta) required for the synthesis of triglycerides in the liver.

The increase of - lipoprotein (lipoprotein) is the result of the increase of triglycerides.

At the same time, lipoprotein lipase activity decreased and the removal rate of triglycerides decreased, so it was easy to form hypertriglyceridemia.

This change may be related to the accumulation of methyl guanidine.