Clinical manifestations and symptoms of end-stage renal disease

Due to various reasons such as food, kidney disease has become a common disease. Every year, people die from kidney disease. If it is discovered early, there may still be a chance for treatment, but if it reaches the terminal stage, there is basically no hope of cure. Moreover, patients will suffer a lot when they reach the terminal stage. All aspects of the body are affected.

1. Water:

It manifests as water retention or dehydration. When the renal tubular concentrating function is impaired, there may be increased nocturia and hypotonic urine may be excreted. When glomeruli are severely damaged, filtration decreases and oliguria occurs.

2. Sodium:

Normal kidneys have the function of conserving sodium. This function is also affected when renal function is impaired. Therefore, for patients with chronic renal failure, there is no need to strictly limit sodium intake unless there is water and sodium retention.

3. Potassium:

Patients with advanced renal failure often have elevated blood potassium, especially those with oliguria, metabolic acidosis, improper medication, and those in a high decomposition state, which may lead to fatal hyperkalemia.

4. Calcium-phosphorus imbalance:

In patients with chronic renal failure, phosphorus excretion is reduced, resulting in elevated blood phosphorus, and the kidney's ability to produce active vitamin D₃ is impaired, leading to decreased blood calcium. The decrease in blood calcium concentration stimulates the increase in parathyroid hormone (PTH) secretion, resulting in secondary parathyroid function hyperfunction.

5. Magnesium:

When the glomerular filtration rate is lower than 30 ml/min, hypermagnesemia may occur, with symptoms such as poor appetite and drowsiness.

6. Acid-base imbalance:

Acidosis occurs when renal function decreases, the excretion of acidic substances decreases, and the ability of the renal tubules to secrete H+ and NH/ decreases, resulting in a decrease in the concentration of HCO2 in plasma. (2) Digestive system: usually manifested as lack of appetite, nausea, vomiting, etc., the patient has a bad taste in the mouth, and may have gastrointestinal bleeding. (3) Cardiovascular system: manifested by varying degrees of hypertension; there may be uremic cardiomyopathy, heart failure, arrhythmias, and late-stage or dialysis patients may have symptoms of pericarditis and rapid progression of atherosclerosis. (4) Blood system: Most cases are normocytic normochromic anemia. In the 2006 K/DOQI guidelines for the treatment of renal anemia, the diagnostic criteria for renal anemia are HB <13.5 g/dl in adult males and <12 g/dl in adult females. (5) Nervous and muscular systems: In the early stages, patients often experience mental symptoms such as fatigue and insomnia. As the disease progresses, they develop symptoms of uremic encephalopathy and peripheral neuropathy, and may also experience drowsiness, convulsions, and coma.

7. Renal osteodystrophy:

① High-turnover bone disease, namely hyperparathyroidism bone disease and osteitis fibrosa, is characterized by increased bone remodeling and abnormal bone mass; ② Low-turnover bone disease is characterized by decreased bone mineralization and bone formation, including osteomalacia and adynamic bone disease; ③ Mixed osteodystrophy is characterized by the coexistence of hyperparathyroidism bone disease and bone mineralization disorders. The gold standard for diagnosis is bone biopsy.

8. Respiratory system:

Chronic renal insufficiency may cause metabolic acidosis, deep and long breathing, water retention, heart failure, and sometimes pulmonary edema.

9. Endocrine System:

① The kidney's own secretion of EPO decreases, leading to anemia, and the secretion of active vitamin D3 decreases, leading to renal osteodystrophy. The kidney's function of degrading and eliminating hormones is reduced, leading to the accumulation of some hormones in the body, such as insulin. ② There are symptoms of impaired thyroid and gonadal function, such as low body temperature, fear of cold, amenorrhea, infertility, etc.

10. Metabolic disorders:

Patients with chronic renal insufficiency have abnormal metabolism of protein, amino acids, fat and carbohydrates.