Why do these manifestations occur in end-stage renal failure?

Question

Explain why each of the following manifestations occurs in end-stage renal failure: 

1. Metabolic acidosis 
2. Hyperkalemia 
3. Hypocalcemia 
4. Increased BUN and serum creatinine 
5. Anemia 
6. Impaired clotting 
7. Edema 
8. Increased blood pressure 
9. Cardiac dysrhythmias 
10. Lethargy, confusion 
11. Muscle weakness 
12. Bone pain 
13. Severe pruritus 
14. Ammonia odor on breath 

Answer 1

Hi Alesha!

See below for my answer to each one of your questions. This requires two posts, because its a long one!:

1/2

1. Metabolic acidosis 
2. in ESRD, there is impaired ammonia excretion, reduced tubular bicarbonate reabsorption and insufficient renal bicarbonate production in relation to the amount of acids synthesized by the body and ingested with food. This in turn results in much more acid being present in the body compared to the basic bicarbonate, explaining the metabolic acidosis.
3. Hyperkalemia 
4. It can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space
5. Hypocalcemia 
6. Hypocalcemia in chronic renal failure is due to two primary causes - increased serum phosphorus and decreased renal production of 1,25 (OH)2 vitamin D. The former causes hypocalcemia by complexing with serum calcium and depositing it into bone and other tissues.
7. Increased BUN and serum creatinine 
8. Urea nitrogen is a normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism. It is normally removed from your blood by your kidneys, but when kidney function slows down, the BUN level rises.
9. Creatinine is a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises.
10. Anemia 
11. The peri-tubular cells of the kidney are responsible for secreting erythropoietin a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues, specifically when you have a decrease in RBC mass. So, without enough EPO, you get an anemia! Specifically, Anemia of Chronic Renal disease
12. Impaired clotting 
13. Patients with ESRD traditionally have low platelet counts. Low platelets would lead to impaired clotting (something called thrombocytopenia). Platelet clotting is also dependent on key factors, including ADP and serotonin. These molecules induce platelet aggregation and degranulation, allowing for a primary hemostatic plug to be formed. Under normal conditions, ADP and serotonin are secreted to attract more platelets. In renal failure patients, their platelet granules have decreased levels of ADP and serotonin.
14. Platelet dysfunction in renal failure can also be attributable to high levels of small molecules known as uremic toxins, hence the term “uremic thrombocytopathy.” Although a variety of moieties contribute to platelet dysfunction or abnormal interactions between platelets and the vascular wall, urea remains a potential factor. 
15. Edema 
16. Edema means swelling or fluid retention. The edema associated with kidney disease usually occurs in your legs and around your eyes. Kidney damage. Damage to the tiny, filtering blood vessels in your kidneys can result in nephrotic syndrome. In nephrotic syndrome, declining levels of protein (albumin) in your blood can lead to fluid accumulation and edema. Based on osmolarity fluid principles, where there is more protein, water will flow. Hence more protein deposition in the tissue will induce water to flow into tissues causing edema.