Emergencies in Renal Failure and Dialysis Patients.pptVIP

Emergencies in Renal Failure and Dialysis Patients Tintinalli chapter 93 ESRD: irreversible loss of renal function, accumulation of toxins and loss of internal homeostasis. Uremia: clinical syndrome resulting from ESRD. Epidemiology 1999=89,252 new cases/424,179 patients being tx for ESRD Causes: DM=#1, HTN=#2 Therapy: dialysis=70% transplants=30% ESRD deaths: 50% cardiac causes. 10-25% infectious Survival rates for 1,2,5 yrs= 79, 65, 34 % respectively Pathophysiology of Uremia Excretory Failure: causes 70 chemicals to elevate. Urea= major breakdown of proteins. Limit protein intake Biosynthetic Failure: loss of hormones 1,25(OH)3 vit D3 and erythropoietin. 85% of erythropoietin produced by kidney. Vit. D3 deficiency= secondary hyperparathyroidism, renal bone disease. Pathophysiology of Uremia Regulatory Failure: over secretion of hormones , disruption of normal feedback mechanisms Clinical Features of Uremia Neurologic complications: Subdural hematoma: 3.5% of ESRD, HTN, head trauma, bleeding dyscrasias, anticoagulants, ultrafiltration. Uremic Encephalopathy: nonspecific centreal neurologic symptoms, responds to dialysis. Neurologic complications: Dialysis Dementia: like uremic encephalopathy but progressive and fatal, seen after 2 years on dialysis Peripheral neuropathy: 50% of HD patients. “glove and stocking pattern”, improves after transplant Autonomic dysfunction: common; dizzy, impotence, bowel dysfunction. Cardiovascular complications: prevalence is greater in ESRD d/t pre-existing conditions, uremia, toxins, high lipids, homocystine, hyperparathyroidism, dialysis related conditions General population CAD: 12% LV hypert. 20% CHF 5% ESRD 40% 75% 40% Creatine protein Kinase MB, Troponin I and T…….NOT significantly elevated in patients undergoing regular dialysis, have been shown to be specific markers in these patients. HTN: 80-90% of ESRD starting dialysis. d/t volume, vasopressor effects of kidney, RAS system. Tx initially w/ volume control C