Post Date December, 03 2023
1. Digestive system is the earliest and most common symptom.
(1) Anorexia (anorexia often occurs earlier).
(2) Nausea, vomiting, abdominal distension.
(3) Tongue and oral ulcer.
(4) There is ammonia odor in the mouth.
(5) Upper gastrointestinal bleeding.
2. Blood system
(1) Anemia is a necessary symptom of uremic patients. The degree of anemia is parallel to the degree of uremia (renal function), and the reduction of erythropoietin (EPO) is the main reason.
(2) The bleeding tendency can be manifested as skin and mucous membrane bleeding, which is related to increased platelet destruction and prolonged bleeding time. It may be caused by toxins, and dialysis can be corrected.
(3) Leukocyte abnormalities Leukocyte reduction, weakened chemotaxis, phagocytosis and bactericidal ability, prone to infection, can be improved after dialysis.
3. The cardiovascular system is the most common cause of death in renal failure.
(1) Most patients with hypertension (more than 80%) have different degrees of hypertension, which can cause arteriosclerosis, left ventricular hypertrophy and cardiac failure.
(2) Cardiac failure often presents with cardiomyopathy, which is caused by retention of water and sodium, hypertension, uremic cardiomyopathy, etc.
(3) Pericarditis is caused by ureaemia or inadequate dialysis. It is mostly bloody, and is usually late.
(4) Atherosclerosis and vascular calcification can progress rapidly, especially in hemodialysis patients. Coronary artery, cerebral artery and systemic peripheral artery can occur, mainly due to hyperlipidemia and hypertension.
4. Nervous and muscular system
(1) Early fatigue, insomnia, inattention, etc.
(2) In late peripheral neuropathy, the sensory nerve is more prominent than the motor nerve.
(3) Dialysis disequilibrium syndrome is related to dialysis and often occurs in patients undergoing initial dialysis. The decrease of urea nitrogen is too fast, and the imbalance of internal and external osmotic pressure leads to the increase of intracranial pressure and brain edema. The symptoms include nausea, vomiting, headache, and convulsion in severe cases.
5. Renal osteopathy refers to the general term of bone changes in uremia. Hypocalcemia, hyperphosphatemia and active vitamin D deficiency can induce secondary hyperparathyroidism; The above factors also lead to renal osteodystrophy (i.e., renal osteopathy), including fibrocystic osteoarthritis (high turnover osteopathy), osteomalacia (low turnover osteopathy), osteogenesis and mixed osteopathy. Renal osteopathy can be clinically manifested as:
(1) It can cause spontaneous fracture.
(2) Symptoms are rare, such as bone ache, walking inconvenience, etc.
6. Respiratory system
(1) The breath is deep and long in acidosis.
(2) Uremic bronchitis, pneumonia (butterfly wing), pleuritis, etc.
7. Skin symptoms
Skin itching, urea cream deposition, uremic face, dialysis can not improve.
8. The main manifestations of endocrine dysfunction are:
(1) Endocrine dysfunction of kidney itself, such as 1,25 (OH) 2 vitamin D3, insufficient erythropoietin and excessive renin-angiotensin II in kidney;
(2) Most patients with peripheral endocrine dysfunction have secondary hyperparathyroidism (elevated blood PTH), insulin receptor disorder, and elevated glucagon. About 1/4 of the patients had a slight decrease in thyroid hormone level. Some patients may have hypogonadism, manifested as gonadal maturation disorder or atrophy, low libido, amenorrhea, infertility, etc., which may be related to factors such as abnormal serum sex hormone levels.
9. Complicated with severe infection
It is easy to be complicated with infection, especially lung infection. Fever during infection may not be obvious in normal people.
