Chronic Renal Failure Complications

Complications of Chronic Renal Failure

• Platelet Abnormalities: Characterized by decreased platelet count and increased turnover, leading to bleeding disorders.
• Metabolic Acidosis: Impaired tubular cell function results in an accumulation of acids (phosphate, sulfuric, hippuric) causing congestive heart failure and muscle weakness.
• Hyperkalemia: Inadequate potassium excretion due to dysfunctional nephrons; can be aggravated by potassium-sparing diuretics.
• Renal Bone Disease: Decreased calcium, increased phosphate and parathyroid hormone disrupt vitamin D utilization, causing demineralization and possible metastatic calcification.
• Multiple Endocrine Disorders: Altered hormone production leading to reproductive issues, insulin clearance problems, and associated metabolic dysregulation.
• Cardiovascular Disorders: Includes left ventricular hypertrophy, fluid retention, and dysrhythmias, along with risks of pericarditis and congestive heart failure.
• Anorexia and Malnutrition: Poor appetite and nausea contribute to hypoalbuminemia, exacerbated by restrictive diets.

Renal Dialysis

• Indication: Primarily for patients progressing to end-stage renal disease (ESRD) or acute conditions.
• Peritoneal Dialysis: Involves placing a catheter in the peritoneum to instill and drain sterile dialysate. It's preferred by those seeking independence and fewer dietary restrictions.
• Continuous Ambulatory/Continuous Cyclic Peritoneal Dialysis: Features continuous exchanges or longer retention times with nightly drainage.

Hemodialysis

• Frequency: Typically performed 3 times weekly for 3-4 hours; alternative short daily sessions are available.
• Considerations: May interfere with daily activities, requiring strict dietary and fluid restrictions. Vascular access is needed, and heparin is used for anticoagulation.
• Process: Blood is circulated through a dialyzer, a synthetic membrane that filters waste.

Complications Associated with Dialysis

• Hemodialysis Complications: Risk of atherosclerosis, anemia, fatigue, hypotension, muscle cramps, and potential for dialysis disequilibrium.
• Peritoneal Dialysis Complications: Mostly minor but can include peritonitis, leakage of dialysate, bleeding, and abdominal hernias.

Urinalysis Components

• Color and Appearance: Normal is pale yellow to amber; may appear cloudy due to infections.
• Odor: Slight odor; changes in odor may indicate infection or consumption of certain foods.
• Specific Gravity and pH: Ranges from 1.015 to 1.025 and usually between 4.5 to 8, average at 5-6.
• Sediment Analysis: Identifies casts (red, broad, white) associated with various renal conditions.
• Negative Markers: Glucose, ketones, protein, blood, bilirubin, and nitrates should be negative; abnormal findings indicate pathology.

Renal Function Studies

• Specific Gravity and Osmolality: Measures kidney concentration ability; normal values are 1.015-1.025 for gravity and 275-295 mOsm/kg for serum osmolality.
• Uric Acid Levels: Varies by age and sex, increases with renal failure.
• Creatinine Levels in Serum and Urine: Normal ranges differ by age and sex; elevations indicate renal impairment.

Respiratory System Fundamentals

• Gas Exchange: Oxygen is transported to cells and exchanged for carbon dioxide; influenced by pressure, airflow, and lung compliance.
• Compliance Factors: Decreased with conditions like pneumothorax, ARDS, and increased with diseases like emphysema.

Acidosis Types

• Metabolic Acidosis: Causes include increased fixed acids or loss of base; diagnosed with decreased pH and altered bicarbonate levels.
• Respiratory Acidosis Causes: Includes COPD, sedative overdose, obesity, and severe pneumonia; characterized by hypoventilation and associated symptoms like headache and drowsiness.

Pediatric Respiratory Conditions

• Acute Laryngotracheobronchitis: Viral infection causing swelling of the airway; managed with humidified air and steroids.
• Acute Tracheitis: Often bacterial; may lead to airway obstruction; treated with antibiotics and possibly intubation.
• Bronchitis: Viral or bacterial inflammation with a productive cough; treated symptomatically, antibiotics not indicated for viral cases.

Chronic Bronchitis

• Definition: Lasting cough and sputum for at least 2 consecutive years; associated with airway irritation and infections.
• Symptoms and Treatment: Cough, dyspnea, frequent infections; managed with bronchodilators and corticosteroids as needed.

Pneumonia

• Causes: Can be viral, bacterial, or due to chemical exposure; presents as inflammation filling alveoli with exudate.
• Pneumonia Types: Lobar, bronchial/lobular, and interstitial, each defined by the location of inflammation.

Streptococcus pneumoniae

• Role in Pneumonia: Most common bacterial cause; vaccine introduction significantly reduced incidence in vaccinated populations.
• Mechanism: Induces inflammation leading to alveolar filling and consolidation.### Pneumonia Overview
• Pleural effusions, super infections, bacteremia (15-25%), and pericarditis are potential complications.
• Symptoms include abrupt onset with high fever (≥105°), chills, diaphoresis, cyanosis, chest pain, tachypnea, and tachycardia.
• Altered consciousness and productive cough with rusty or green-tinged mucus may also present.

Treatment Options for Pneumonia

• Common treatments include:
  • Antipyretics for fever relief.
  • Analgesics for pain management.
  • Respiratory support as needed.
  • Antibiotics: options include penicillins, ampicillin, 3rd generation cephalosporins, macrolides, erythromycin, tetracycline, and fluoroquinolones.

Haemophilus Influenzae

• Colonizes upper respiratory tracts in children under 5, often leading to pneumonia.
• Conjugated polysaccharide H. influenzae type b vaccine introduced in 1990 significantly reduced pneumonia cases.
• Symptoms may emerge 2-6 weeks post upper respiratory infections; include fever, chills, and a productive cough.
• Complications include bacteremia, lung abscesses, pleural effusions, epiglottitis, and pericarditis.

Viral Pneumonias

• More common in adults; RSV particularly affects children under 5, potentially leading to pneumonia.
• Viruses like adenoviruses, parainfluenza, cytomegalovirus, and coronaviruses can also cause pneumonia.
• Symptoms include progressive cough, fever, dyspnea, cyanosis, and respiratory distress.
• Treatments include rest, fluids, antipyretics, oxygen therapy, and ribavirin aerosol for severe RSV cases.

Mycoplasma Pneumoniae

• Caused by pleomorphic microorganisms affecting cilia function and provoking an inflammatory response.
• Primarily affects children and young adults aged 4-20; only about 3% develop pneumonia.
• Occurs seasonally and in 4 to 8-year epidemic cycles.
• Symptoms include paroxysmal cough, low-grade fever, myalgia, and diarrhea.

Hospital-Acquired Pneumonia (HAP)

• HAP is significantly more lethal than community-acquired pneumonia (CAP), with death rates ranging from 20-40%.
• Mortality can rise to 90% if patients are on mechanical ventilation.
• Pseudomonas aeruginosa is a leading cause of HAP, associated with 40-60% mortality.
• Transmitted through contaminated hands of healthcare staff or invasive devices, particularly risky for cystic fibrosis patients.
• Symptoms include fever, cough, bradycardia, elevated WBC counts.

Aspiration Pneumonia

• Results from aspiration of foreign objects or fluids, triggering an inflammatory response.
• Common causes are fluid or food aspiration, with young children at high risk during feeding.
• Symptoms mimic other pneumonia types: cough, dyspnea, respiratory distress, cyanosis.
• Treatment involves removal of foreign objects, antibiotics, respiratory support, and preventive measures during feeding.

Bronchiolitis (RSV)

• Bronchiolitis is characterized by bronchiolar inflammation primarily due to respiratory syncytial virus (RSV).
• Also associated with adenoviruses, parainfluenza, and Mycoplasma pneumoniae.