Question

1. Chronic Renal Failure has many systemic effects. Provide a brief explanation of the mechanism of how each of the following is affected:

a. neurologic functioning-  

b. cardiovascular efficiency-

c. musculoskeletal changes-

d. gastrointestinal alterations-

Answer 1

Chronic renal failure- systemic effects

Neuologic functioning

• Both central and eripheral nervous system are affected.
• Uremia, decresed clearance of neurotoxins, altered hemodynamics, coexisting illnesses all contribute to dysfunction.
• CNS changes can be behavioural alterations, asterixis and even convulsions or encephalopathy
• Autonomic neuropathy is also common
• In dialysis patients, dialysis dementia( due to retained aluminium salts of diasylate- not common now) and dialysis disequilibrium ( due to sudden osmotic gradient due to decreased clearance of urea from brain) can occur

Cardiovascular:

• Systemic hypertension is common- sodium and water retension, altered RAAS functioning
• Accelerated atherosclerosis and impaired triglyceride clearance- Ischemic heart disease common and a cause of mortality.
• Hypocalcemia and hyperphosphatemia can lead to metastatic calcification of heart valves.
• Hyperkalemia and other electrolyte abnormalities can trigger arrhythmias.

Musculoskeltal system

• Vitamin D deficiency causes hypocalcemia. Hyperphosphatemia due to CRF can cause PTH secretion and this can lead to tissue deposition of Calcium phosphate- Osteitis fibrosa cystica
• Incraesed protein loss- muscle wasting
• Osteoporosis

Gastrointestinal system:

• Uremia can lead to gastric mucosal irritation. This can trigger GI bleeds.
• Delayed gastric emptying- autonomic gastropareisis
• Anorexia, nausea, vomiting due to uremia