|
MUSCULOSKELETAL COMPLICATION
Clinical complications of chronic
kidney
failure
The
clinical complications of chronic
kidney failure are
widespread
such as:
Musculoskeletal
System
Chronic
renal failure causes major problems in the skeleton.
Osteitis fibrosa, osteomalacia, and reduced bone
turnover are a consequence of hyperparathyroidism,
phosphate retention, and deranged vitamin D
metabolism. These manifest as bone pain, deformity,
pathological fractures, soft tissue and especially
vascular calcification, and proximal myopathy.
Patients
are also prone to develop crystal arthropathy,
either from urate or pyrophosphate. Uric acid
concentrations are high because of reduced excretion
and the effect of diuretics. Long-term dialysis
patients develop a specific b2-microglobulin
amyloid, deposits of which cause a large joint and
spinal arthropathy, and the carpal tunnel syndrome.
Large-joint haemarthroses are seen in anticoagulated
renal failure patients, probably because of synergy
between the use of heparin and uraemia-associated
effects on haemostasis. Gout can be prevented with
xanthine oxidase inhibitors such as allopurinol (but
note the need for a reduced dosage in patients with
renal impairment), or uricosuric agents such as
probenecid. Initiation of these agents should be
covered by colchicine for they can provoke acute
attacks. NSAIDs can be used during acute attacks in
chronic renal failure for short periods, provided
that the effect on salt retention and GFR is
acknowledged. Colchicine or corticosteroids are
alternatives. The cyclo-oxygenase-2 inhibitors do
not have an advantage over conventional agents.
| 
