KIDNEY DISEASES: CLINICAL FINDINGS FOR RENAL FAILURE
Renal failure indicates that the kidneys are no longer able to fulfill their functions adequately. Uremia refers to the retention of urea and other constituents in the blood together with the pattern of symptoms that accompany such retention. Azotemia refers specifically to the accumulation of nitrogenous constituents in the blood. When the glomerular filtration rate (GFR) is less than 10 ml per minute (normal is 125 ml per minute) and the blood urea nitrogen (BUN) is 80 mg per 100 ml or more, symptoms of uremia appear. With appropriate dietary management these symptoms can be controlled. When the GFR is 3 ml per minute, dietary modification alone is not adequate and dialysis is needed.
Acute renal failure sometimes occurs from the trauma associated with burns, accidents, or surgery, or from the ingestion of poisons. These patients are oliguric or even anuric. It is an emergency situation that often requires dialysis.
Chronic renal failure is the final outcome of chronic glomerulonephritis or may be associated with poor circulation because of extensive atherosclerosis or cardiac failure.
In renal failure the patient has an elevated blood urea nitrogen, acidosis, anemia, and usually excretes little or no urine. These changes produce gastrointestinal upsets such as anorexia, nausea, vomiting, bad breath, and ulcerations of the mouth. These symptoms make it difficult for the patient to eat.
Other symptoms include headache, muscle twitching, sometimes blurred vision, and serious interference with heart function. The inability to excrete sodium and water can lead to congestive heart failure. Elevation of the serum potassium can block heart action leading to death.
Because the kidney is unable to produce active vitamin D the absorption of calcium is reduced. The serum calcium is below normal, and abnormal amounts of calcium are released from bone leading to renal osteodystrophy. On the other hand the serum phosphorus level is elevated. This causes further release of calcium and phosphorus from bone, resulting in a vicious cycle.
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GENERAL HEALTH

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