DISORDERS OF THE

URINARY SYSTEM

CHRONIC R

ENAL

FAIL

URE

DR. ASMATULLAH SAPAND

A H M A D S H A H A B D A L I I N S T U T U T E O F H I G H E R E D U C AT I O N D E P A R T M E N T O F I N T E R N A L M E D I C I N E K H O S T - A F G H A N I S T A N

10 . 05 . 2 016

MANAGEMENT OF COMPLICATIONS

ENDOCRINE ABNORMALITIES:• Amenorhea in females.• loss of libido in both sexes(hyperprolactinemia)

MANAGEMENT OF COMPLICATIONS

CVS DISORDERS:• Hypertension(80%)• Atherosclerosis• Pericarditis

MANAGEMENT OF COMPLICATIONS

ACIDOSIS:• Metabolic acidosis(irregular acid-base balance)

MANAGEMENT OF COMPLICATIONS

INFECTIONS:• Both cellular and humoral immunity are

impaired.• UTI is common.

MANAGEMENT OF COMPLICATIONS

SKIN ABNORMALITIES:• Pruritus• Yellow-brown skin pigmentation.

MANAGEMENT OF COMPLICATIONS

NEUROMUSCULAR DISTURBANCES:• Neuropathy: - secondary N (paraesthesia) - motor N (foot drop) - autonomic (postural hypotension, GI-motility disorders)• Myopathy: (poor nutrition, hyperparathyroidism, vit.D

deficiency, and electrolyte disturbance)

MANAGEMENT OF COMPLICATIONS

INDICATIONS FOR DIALYSIS IN CKD:• Uremic symptoms (pericarditis, encephalopathy, seizures, or

coagulopathy)• Fluid overload unresponsive to diuretics• Refractory Hyperkalemia• Severe metabolic acidosis (PH<7.2)• Serum creatinine about 10mg/dl and urea 200md/dl.• PATIENT TYPICALLY REQUIRE HEMODIALYSIS 3-TIMES-

PER-WEEK.

MANAGEMENT OF COMPLICATIONS

COAGULOPATHY: DUE TO PLATELET DYSFUNCTION IN CKD, resulting in Petechiae, Purpura, and increased tendency for bleeding during surgery.ENCEPHALOPATHY: (GFR<10-15ml/min)Resulting from uremia, accumulation of other toxins and hypercalcemia(>14-15mg/dl)HEART FAILURE: features of both right and left HF.

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