Alesha V.

asked • 04/08/21

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

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 

1 Expert Answer


Haley T.

2/2 8. Increased blood pressure  As stated above, High blood pressure also damages the tiny filtering units in your kidneys. As a result, the kidneys may stop removing wastes and extra fluid from your blood. The extra fluid in your blood vessels may build up and raise blood pressure even more. Additionally, ESRD hypertension can be attributed in part to the result of extracellular volume expansion, increased or inappropriate response of the renin-angiotensin-aldosterone system (RAAS) due to increased renin secretion and overactivity of the sympathetic system. 9. Cardiac dysrhythmias  Damaged kidneys may release too much renin. In ESRD, the increased renin secretion can lead to over-activation of the renin-angiotensin-aldosterone system (RAAS), and as a result leads to increased blood pressure and in turn, increased high blood pressure. High blood pressure increases the risk of heart attack, congestive heart failure and stroke. The alterations in cardiovascular system, metabolic homeostasis and autonomic nervous system may also facilitate the occurrence of cardiac arrhythmias in ESRD. 10. Lethargy, confusion  In ESRD, you get can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate. Another complication of kidney disease is anemia, which can cause weakness and fatigue. Additionally, a 2009 study by Bossola et al, suggest that markers of systemic inflammation, C-reactive protein, and IL-6, and decreased levels of albumin are associated with fatigue in individuals with ESRD who are receiving dialysis. The buildup of toxic metabolites can affect the brain, leading to severe confusion in patients with ESRD, especially in the final days of life. 11. Muscle weakness  Severe loss of kidney function causes metabolic wastes to build up to higher levels in the blood due to impaired renal filtration. Damage to muscles and nerves can cause muscle twitches, weakness, cramps, and pain. 12. Bone pain  The bone pain is a result of the renal osteodystrophy that occurs in ESRD. Hypocalcemia, hyperphosphatemia, and failure of vitamin D hydroxylation in ESRD are associated with chronic kidney disease. This can lead to hyperparathyroidism, which results in high serum phosphate, which can bind with calcium and deposit in tissues. This leads to decreased serum calcium causing subperiosteal thinning of bones which is a painful process and can predispose the patient to fractures. 13. Severe pruritus  Pruritus is a term for feeling itchy. The abnormalities of calcium metabolism that occur in the setting of ESRD may lead to the formation of calcium phosphate crystals in the skin. These crystals may stimulate itch receptors. 14. Ammonia odor on breath  This is a classic sign and symptom of metabolic acidosis!


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