天津医科大学内科学课件 Chronic Renal.pptVIP

CARDIOVASCULAR EFFECTS. Mortality from cardiovascular disease in renal failure patients is three and a half times that of an age-matched population. Hypertension is common in renal failure and is usually aggravated by fluid retention. More than 60% of patients starting dialysis have echocardiographic(UCG) manifestations of left ventricular hypertrophy, dilation, and systolic or diastolic dysfunction. Pericarditis can occur in uremic patients before initiating dialysis and in patients already on dialysis. NEUROLOGIC MANIFESTATIONS. subtle changes in cognitive function, and memory and sleep disorders. Lethargy, asterixis, and, seizures, these are usually avoided by early start of dialysis therapy. Peripheral neurologic manifestations present as a symmetric sensory neuropathy in a glove and stocking distribution. DERMATOLOGIC MANIFESTATIONS. Pruritus is a common complaint of patients with renal failure, and the exact etiology is not certain. It usually responds to dialysis, control of hyperparathyroidism, improved calcium and phosphate balance MUSCULOSKELETAL MANIFESTATIONS. Alterations in calcium and phosphate homeostasis and renal osteodystrophy are common manifestations of uremia. hyperparathyroidism are the result of phosphate retention and lack of l-alpha hydroxylase activity in the failing kidney, which results in deficiency of the most active form of vitamin D. Control of hyperparathyroidism with phosphate binders, calcium supplementation, and 1, 25 Vitamin D together with dialysis therapy is now achievable. ENDOCRINE ABNORMALITIES Symptoms of hypothyroidism and the uremic syndrome may overlap. Deranged pituitary gonadal axis can result in impotence, amenorrhea, sterility, and uterine bleeding. METABOLIC DISORDERS As renal function diminishes, many diabetic patients have a decrease in their insulin requirements. This is partly due to the increased half-life of exogenously administered insulin. increase in plasma triglycerides and less of an incre