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HEMATOLOGICAL COMPLICATION
Clinical complications of chronic
kidney
failure
The
clinical complications of chronic
kidney failure are
widespread
such as:
Hematological Effects
Renal
anaemia, which is normochromic and normocytic,
accounts for many of the symptoms that previously
were attributed to uraemia. These include lethargy,
cold intolerance, and loss of stamina. Anaemia
increases the cardiac output and therefore
contributes to the development of left ventricular
hypertrophy and dilatation. The low haematocrit
itself has an effect on platelet function as
measured by prolonged bleeding times.
Platelet
numbers are usually normal but function is impaired
at the level of endothelial contact. The coagulation
system is not affected. The uraemic bleeding
diathesis manifests as occult gastrointestinal blood
loss, oozing from any injuries or surgical incision,
menorrhagia, and epistaxes. It is aggravated by the
consumption of aspirin, a regular component of drug
regimens in patients with cardiovascular disease.
T-cell
immunity is impaired in renal failure, but the
mechanism has not been explained. Evidence for this
defect is the higher risk of reactivation of
tuberculosis and herpes zoster, a failure to clear
hepatitis B, and a poor response to immunization
with hepatitis B vaccines. Neutrophil function is
abnormal in a number of in vitro tests and may
explain the high incidence and severity of bacterial
infections, especially those associated with
vascular access. The defect is attributed to the
effects of iron, increased cytosolic calcium, and
'granulocyte inhibitory proteins'.
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