Systemic Effects of Uremi Allterations of Renal and Urinary Tract Function Chapter 29 808 nee ae Syst Skeletal Cardiopulmonary Cardiovascular Neurologic Hematologic Gastrointestinal Integumentary Immunologic Reproductive Mani ‘Spontanoous fractures and bone st of long bones Pulmonary edema, Kussmaul respirations Left ventricular hypertrophy, ‘cardiomyopathy, and ischemi heart disease; hypertension, archythmias, accelerated atherosclerosis; pericarditis with fever, chest pain, and pericardial friction rub Encephalopathy (fatigue, loss of attention, dificulty with problem solving); peripheral ‘neuropathy (pain and burning in the legs and feet, loss of vibration sense and deep tendon reflexes); loss of motor coordination, twitching, fasciculations, stupor, and ‘coma with advanced uremia Anemia, usually normochromic normocytic: platelet disorders with prolonged bleeding times ‘Anorexia, nausea, vomiting: ‘mouth ulcers, stomatiti urinous breath (uremic factor), hiccups, peptic ulcers, ‘gastrointestinal bleeding, and pancreatitis associated with end-stage renal failure ‘Abnormal pigmentation and pruritus Increased risk of infection that ‘can cause death; increased risk of carcinoma ‘Sexual dysfunction: amenorthea, infertility, and decreased libido in women; decreased Mechanisms Osteits fibrosa: bone inflammation with fibrous degeneration related to hhyperparathyroidism Osteomalacia: bone resorption associated with vitamin D and calcium deficiency Fluid overload associated with pulmonary edema and metabolic acidosis le Kussmaul respirations Extracellular volume expansion ‘and hypersecretion of reni ‘associated with hypertension; ‘anemia increases cardiac workload; hyperlipidemia promotes atherosclerosis; toxins precipitate into pericardium Progressive accumulation of Uremic toxins associated with end-stage renal disease ‘Stroke or intracerebral hemorrhage associated with ‘chronic dialysis Reduced erythropoietin secretion ‘and reduced red cell production; uremie toxins shorten red blood cell survival and alter platelet function Retention of metabolic acids and ‘other metabolic waste products Retention of urochromes, ‘contributing to sallow, yellow color; high plasma calcium levels and neuropathy associated with pruritus Suppression of cell mediated immunity; reduetion in number and funetion of lymphocytes, diminished phagocytosis. Dysfunction of ovaries and testes; presence of neuropathies Treatment Control of hyperphosphatemia to reduce hyperparathyroidism; administration of calcium and aluminum hydroxide antacids, which bind phosphate in the Gut, together with a phosphate- restricted diet; vitamin D replacement; avoidance of magnesium antacids because of impaired magnesium excretion ‘ACE inhibitors; combination of propranolol, hydralazine, and ‘minoxidil for those with high levels of renin; bilateral ‘nephrectomy with dialysis or transplantation Volume reduction with diuretics that are not potassium sparing {to avoid hyperkalemia); dialysis Dialysis or successful kidney transplantation Dialysis; recombinant human erythropoietin and iron supplementation; conjugated estrogens; DDAVP (t-desamino- B-p-arginine vasopressin); transfusion Protein-restricted diet for relief of nausea and vomiting Dialysis with control of serum calcium levels Routine dialysis No specific treatment With date trom Keane WE: Kidney Int Suppl 75:527-S3i, 2000; Unbar J: Semin Dial Y]{A}22-298, 2000,