Chronic Kidney Insufficiency: Complications

The following are the major diseases or complications that may be contributed to by chronic renal failure (chronic renal insufficiency) or chronic kidney disease:

Respiratory system (J00-J99)

Blood, hematopoietic organs – immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Activation of protein catabolism (protein degradation).
  • Triggering of a proinflammatory response (inflammatory response).
  • SS-2-microglobulin amyloidosis – deposition of proteins in bones and joints; complication after long-term dialysis (blood washing).
  • Calciphylaxis (synonyms: Uremic calcifying arteriolopathy, abbreviated UCA; metastatic calcification) – severe and painful course of bone loss due to renal disease (renal osteodystrophy) in patients with end-stage renal disease; very rare but potentially life-threatening skin complication; typical are deposits of calcium and phosphate salts in the blood vessel walls and subcutaneous fatty tissue, leading to vasculitis (inflammation of blood vessels), panniculitis (inflammation of subcutaneous fatty tissue) and painful, plaque-like skin necrosis (death of skin)especially on the lower extremities and trunk; lesions show no tendency to heal and develop into necrotic nonhealing ulcers
  • Electrolyte and acid-base disturbances.
    • Hyperkalemia (excess potassium) – disturbed potassium homeostasis (due to metabolic acidosis/metabolic acidosis → increase in extracellular potassium, among other things) → cardiac arrhythmias.
    • Hypermagnesemia (magnesium excess).
    • Hyperphosphatemia (excess phosphate)
      • → renal osteopathy (bone changes (osteomalacia) caused by chronic renal insufficiency).
      • → development of medial vascular calcification (Mönckeberg mediasclerosis), which occurs in the muscle layer of the arteries → increased cardiovascular mortality (cardiovascular mortality).
    • Hypocalcemia (calcium deficiency).
    • Hyponatremia (sodium deficiency)
    • Metabolic acidosis (hyperacidity)
  • Glucose metabolism disorders – disorders of sugar metabolism.
  • Hyperhydration (excess fluid/overhydration) → edema (water retention), hypertension (high blood pressure), left heart failure (left heart failure), pulmonary edema (water retention in the lungs), cerebral edema (brain swelling).
  • Hyperlipidemia/dyslipidemia (lipid metabolism disorders).
  • Hyperparathyroidism (parathyroid hyperfunction), secondary.
  • Hyperphosphatemia (excess phosphate) → renal osteopathy (bone changes (osteomalacia) caused by chronic renal insufficiency).
  • Hyperuricemia/gout (elevation of uric acid levels in the blood )/gout – approx. 2-fold increased risk of gout with an eGFR < 60 ml/min/1.73 m2
  • Hypoglycemia (low blood sugar).
  • Calciphylaxis (synonyms: uremic calcifying arteriolopathy, UCA; metastatic calcification) – severe and painful course of bone loss due to renal disease (renal osteodystrophy) with poor prognosis; characteristic are non-healing wounds with superinfection and progression to sepsis (blood poisoning)
  • Peripheral insulin resistance
  • Growth disorders in children

Skin and subcutaneous tissue (L00-L99)

  • Bullous (blistering) dermatosis (skin disease) due to disturbances in porphyrin metabolism; occurs in dialysis-dependent renal failure.
  • Lichen simplex chronicus – scratching results in a chronic inflammatory, plaque-like and lichinoid (nodular) skin disease
  • Prurigo nodularis – by scratching arise reddish-brown, very itchy nodules.

Cardiovascular system (I00-I99)

  • Apoplexy (stroke)
    • Insb. in patients with high salt consumption.
  • Atherosclerosis
  • Heart failure (cardiac insufficiency) (usually with preserved ejection fraction).
    • Comparing patients with and without chronic kidney disease, after adjustment, the risk of developing heart failure was 2.3
    • Patients with heart failure and kidney disease have a particularly high mortality rate
    • Insb. in patients with high salt consumption.
  • Cardiac arrhythmias
  • Hypertension (high blood pressure)
  • Cardiorenal syndrome (KRS) – simultaneous appearance of heart and kidney failure, in which acute or chronic functional impairment of one organ leads to functional impairment of the other organ
    • Up to 50% of all patients with heart failure (heart failure) have concomitant chronic kidney disease (CKD) (glomerular filtration rate (GFR) persistently <60 ml/min/1.73m2)
    • Patients with moderately impaired renal function (> CKD stage 3 or a GFR < 60 ml/min/1.73m2) have a 3-fold higher risk of heart failure than patients with normal renal function (GFR > 90 ml/min/1.73m2)
  • Coronary artery disease (CAD) – narrowing of the coronary arteries caused by atherosclerosis (arteriosclerosis, hardening of the arteries).
  • Left ventricular hypertrophy (LVH) – enlargement of the left ventricle (heart chamber).
  • Pericardial effusion (effusion of the pericardium), uremic.
  • Pericarditis (inflammation of the pericardium), uremic
  • Peripheral arterial occlusive disease (pAVK) – progressive narrowing or occlusion of the arteries supplying the arms/ (more commonly) legs, usually due to atherosclerosis (arteriosclerosis, hardening of the arteries).

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder and bile ducts – pancreas (pancreas) K70-K77; K80-K87)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Diverticulosis – mucosal protrusions in the intestine.
  • Gastritis (inflammation of the gastric mucosa)

Musculoskeletal system and connective tissue(M00-M99)

Psyche – Nervous System (F00-F99; G00-G99).

  • Encephalopathy (disturbance of brain function), uremic → seizures, disturbances of consciousness (somnolence, sopor and coma).
  • Impotence
  • Neuropathy – nervous diseases of the peripheral nervous system.
  • Psychosis
  • Restless Legs Syndrome (RLS) – restless legs syndrome.

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Cachexia (emaciation; very severe emaciation).
  • Edema (water retention)
  • Pruritus:
    • Nephrogenic pruritus (kidney-related itching).
    • Uremic pruritus
  • Pleurisy (pleurisy), uremic.
  • Uremia (occurrence of urinary substances in the blood above normal values).
  • Xerosis cutis (dry skin) (85% of all dialysis patients).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Amenorrhea – absence of menstruation.
  • Infertility (infertility)
  • Oligospermia – too few sperm in the ejaculate (< 15 million sperm per ml of ejaculate).

Injury, poisoning, and certain other consequences of external causes (S00-T98).

  • Fractures (broken bones)
  • Nephrogenic systemic fibrosis (NSF; synonyms: Nephrogenic fibrosing dermopathy; dialysis-associated systemic fibrosis); occurs in renal failure patients with an estimated glomerular filtration rate < 30 ml/min/1.73 m2 ; initial symptoms include pain, pruritus (itching) swelling, and erythema ((skin redness); cobblestone-like, hypopigmented plaques (areal or squamous substance proliferation of the skin); possibly. also fibrosis (proliferation of connective tissue fibers) of the lungs, liver, muscles, diaphragm and heart; poor prognosis, especially with lung involvement; etiology (cause): exposure to gadolinium-containing contrast media.

Further

  • Increased consumption of antioxidants.
  • Inhibition of lipolysis (fat breakdown).
  • Disruption of immunocompetence

Prognostic factors

  • Hypertension (high blood pressure) is a major risk factor in the progression of chronic kidney disease (CKD)
  • Serum magnesium – worse prognosis even with low normal magnesium; after (median) 5.1 years, patients with low magnesium levels (< 1.8 mg/dl) had 61% higher mortality (death rate) compared with patients with high magnesium levels (> 2.2 mg/dl)
  • Urinary oxalic acid – patients with higher urinary oxalic acid levels showed more rapid loss of renal function; in the fifth with the highest oxalate excretion (above 27.8 mg/24 hours): twice as likely to have disease progression versus in the fifth with the lowest oxalate excretion (below 11.5 mg/24 hours)
  • Proteinuria (increased urinary excretion of protein, especially albumins, and alpha-globulins and beta-globulins).