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KIDNEY COMPLICATION
Clinical complications of chronic
kidney
disease
The
clinical complications of
chronic kidney failure are
widespread
such as:
Cardiovascular System
The
single most important complication of chronic
kidney disease is raised arterial blood pressure, which
accelerates atherosclerosis and is the main cause of
the left ventricular hypertrophy that is found in 75
per cent of patients. Left ventricular dilatation,
coronary atherosclerosis, ventricular dysfunction,
and cardiac failure are common, explaining why
cardiac disease is the leading cause of death in
patients with ESRF, the relative risk being highest
in the young. There is a high risk of acute
myocardial infarction, but sudden arrhythmic death
is the more common fatal cardiac event. Patients are
prone to develop pulmonary oedema with relatively
small increases in extracellular fluid and tolerate
dialytic removal of fluid poorly.
The
factors giving rise to this dangerous combination of
left ventricular hypertrophy and coronary
atherosclerosis operate early in chronic renal
failure and include hypertension, dyslipidaemia,
anaemia, hyperparathyroidism, and
hyperhomocysteinaemia. The combination of these
factors has a synergistic effect on the risk of
cardiovascular disease.
Pericarditis is a dreaded complication of chronic
renal failure because it may lead to tamponade and
death. It was more common in the days when dialysis
was delayed until the patient was extremely uraemic,
but it still occurs in underdialysed, chronically
fluid overloaded, and infected patients. Progression
to constriction is rare.
Calcific
aortic stenosis and mitral valve calcification
leading to incompetence occurs in about one-third of
patients in dialysis. Endocarditis is not uncommon
in haemodialysis patients, but could still be
considered as surprisingly rare considering the
frequency with which access to the circulation is
made. It is usually caused by Staphylococcus aureus
and leads to destructive valve disease often needing
surgery.
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