A gastrointestinal manifestations of this disease first appeared as the most common and prominent symptoms exacerbated with disease progression . Gastrointestinal symptoms are increased urea decomposed by bacteria into ammonia and ammonium carbonate stimulated by the mucous membrane of the gastrointestinal tract , but also with increased levels of gastrointestinal peptide hormones and metabolic disorder caused by the decreased mucosal barrier mechanism . Early loss of appetite, bloating , and nausea, vomiting , hiccups and diarrhea. Patients with advanced oral urine odor , accompanied by oral mucosal erosions ulcers , parotid gland enlargement can even serious gastrointestinal bleeding. Often accompanied by stomach, duodenum inflammation or ulceration .
2 . The spirit of early neurological symptoms were fatigue , dizziness , difficulty concentrating , memory loss and sleep disorders and other symptoms , and thus there is apathy , speech reduced consciousness, unconscious movement of limbs , etc. ; late uremic encephalopathy, drowsiness , delirium , hallucinations , stupor, coma until incontinence . Peripheral neuropathy manifested as skin burning sensation , numbness , " restless legs" and so on. Enhanced neuromuscular excitability , manifested as muscle cramps and convulsions. Some patients may have autonomic dysfunction , manifested as orthostatic hypotension, sweating and neurogenic bladder disorders .
3 . Blood system performance when serum creatinine greater than 309.4μmoL / L, the vast majority of patients with anemia , usually the normal form , are pigmented anemia. And with renal function into - further exacerbated decline . The main causes of renal anemia and renal secretion of erythropoietin (EPO) to reduce , inhibit erythropoiesis substances exist in blood , red blood cells shortened life expectancy, lack of blood substances ( iron and folic acid deficiency ) , aluminum intoxication , infection and so on. Bleeding is also very common, manifested as subcutaneous bleeding , epistaxis , menorrhagia , and gastrointestinal bleeding. Bleeding tendency and prolonged bleeding time , increased platelet destruction and dysfunction, as well as a variety of coagulation factor abnormalities related. White blood cell count were normal , some patients may have neutropenia or lymphopenia .
4 . Hypertension is very common symptoms of the cardiovascular system , the degree of severity can vary , generally systolic and diastolic blood pressure were increased, the occurrence of severe hypertensive encephalopathy . Pericarditis occurs when symptoms are severe uremia , called uremic pericarditis , often have severe left chest pain onset , often pericardial friction rub , pericardial tamponade can occur in severe cases , the exact cause is unknown , some of the uremic toxins . Uremic cardiomyopathy often occurs in patients with advanced , its mechanism and anemia , hypertension, excessive load capacity , hypoxia , acidosis, electrolyte metabolism, energy metabolism , parathyroid hormone and cardiac toxin molecular substances related to clinical manifestations have an enlarged heart , a variety of arrhythmias and congestive heart failure. Heart failure is a common cause of death of uremia , excessive loading capacity is the most common factor , in addition to hypertension , heart disease , arrhythmia, severe anemia and so on. Chronic renal failure patients due to lipid metabolism disorders , atherosclerosis , ischemic heart disease incidence has increased.
5. Respiratory manifestations of metabolic acidosis often have shortness of breath . Or even Kussmaul breathing. Metabolites retention and immune function easily with respiratory tract infections , can be expressed as bronchitis , pneumonia, pleurisy, pleural effusion . Interstitial pneumonia is more common , x -ray examination shows the typical person hilar butterfly-shaped shadow on both sides , called " uremic lung ."
6. Motion system performance uremic myopathy , proximal muscle involvement common. Renal osteodystrophy very common , referred to renal osteodystrophy , including renal rickets , renal bone softening disease , fibrous osteitis , osteoporosis , bone sclerosis , metastatic calcification , and other performance. Few clinical symptoms of bone disease , few showed bone pain, difficulties in walking .
7 . Endocrine disorders can occur , endocrine disorders and chronic renal renin - angiotensin , prolactin and gastrin hypersecretion, thyroid-stimulating hormone , testosterone, cortisol, lower than normal , thyroid, hypogonadism , male lack of sexual desire and impotence, women with advanced renal failure may occur amenorrhea , infertility. Insulin , glucagon , and parathyroid hormone , such as its role in renal failure may be extended .
8. Protein , carbohydrate and fat metabolism in chronic renal failure often has negative nitrogen balance. Low levels of essential amino acids , normal or low fasting glucose , impaired glucose tolerance is often diminished, often elevated triglyceride levels , low and low-density lipoprotein also increased.
9. Immune dysfunction, reducing the number of peripheral blood lymphocytes , a variety of lymphocyte subsets and functional abnormalities . Produce immunoglobulin deficiency , immune dysfunction , easy with respiratory , urinary tract and skin infections , likely to develop sepsis.
10. Skin symptoms pale complexion , dark stagnation , mild swelling sense , the performance of uremia face. Dry skin, scaling , dull, pigmentation. Common intractable skin itching , and urea cream and calcium calm and so on. Sometimes bruising , itching and lowered immunity due , prone to cause purulent skin infections.
11. Water, electrolyte and acid-base balance of performance
( 1 ) excessive loss of water or water : water metabolism in normal kidney can perform a wide range of adjustment. When renal failure due to poor concentration function , nocturia , polyuria , with anorexia , vomiting , diarrhea, can lead to dehydration, poor drainage due to renal , drinking water or improper fluid , prone to water retention , manifested as edema , hypertension , heart failure , and even serious consequences pulmonary edema, cerebral edema occur.
( 2 ) hyponatremia and hypernatremia : Due to vomiting, diarrhea, loss of too much sodium , reduce tubular sodium reabsorption , prone to hyponatremia , manifested as fatigue, anorexia. Severe hypotension and even coma. When such a sudden increase in sodium intake , prone to water and sodium retention , hypertension, edema and heart failure.
( 3 ) potassium and hypokalemia : oliguric renal excretion of potassium decreased. Increased body catabolism , metabolic acidosis extracellular K + to transfer, use retention of potassium-sparing diuretics or angiotensin converting enzyme inhibitors , can cause severe hyperkalemia. Manifested as lethargy, severe arrhythmias , or even cardiac arrest . If you eat less , potassium intake , nausea . Vomiting, diarrhea, and long-term application of potassium- sparing diuretics . Prone to hypokalemia. Manifested as fatigue, weakness , abdominal distension , limb paralysis. In severe cases of serious arrhythmias and respiratory muscle paralysis .
( 4 ) hypocalcemia and hyperphosphatemia : renal failure renal tissue can not generate active vitamin D3, reducing the absorption of calcium from the intestine , which occurred hypocalcemia. A little boat symptoms . Just in time to correct the acidosis with sodium bicarbonate to reduce free calcium and precipitating tetany . Nephron hyperphosphatemia appears to reduce phosphorus excretion . Hyperphosphatemia can increase blood calcium and phosphorus product . Hypocalcemia make PTH secretion, prone to renal osteodystrophy , metastatic calcification .
( 5 ) Hypermagnesemia : renal failure due to renal excretion of magnesium reduced, while the intestinal absorption of magnesium is still normal . Can cause hypermagnesemia . Manifested as fatigue, skin flushing , burning and so on. Severe hypomagnesemia may occur with severe symptoms of respiratory and cardiac paralysis.
( 6 ) metabolic acidosis : chronic renal failure due to the following reasons caused metabolic acidosis ;
① renal failure metabolites such as phosphoric acid , sulfuric acid and other acidic substances acetoacetate barriers due to renal excretion retention ;
② tubular secretion of hydrogen ions function is impaired , resulting in hydrogen, sodium ion exchange reduced, thus making hydrogen retention and re-absorption of sodium bicarbonate can be lost in the urine ;
③ tubular cell manufacturing capacity to reduce ammonia , uric acid dysfunction, alkali salt can not be retained . Mild metabolic acidosis usually no clinical symptoms, blood poisoning, severe PH decreased acid anion gap was significantly higher than normal , patients with fatigue, anorexia , nausea, vomiting , abdominal pain , headache , irritability , appeared deep and long breath . In severe cases, coma , heart failure , decreased blood pressure and cardiac arrest.
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