Renal impairment encompasses both acute and chronic renal failure, which may develop as a result of numerous disorders. The clinical presentation ranges from asymptomatic to life-threatening shock, depending on the severity of impairment. The diagnosis rests on the ability of the physician to recognize clinical features and conduct a thorough laboratory workup, while the determination of the glomerular filtration rate is the cornerstone in determining the degree of renal failure.
A myriad of disorders may cause the inability of the kidneys to perform their respective function, and the term renal impairment encompasses two major disorders - acute and chronic kidney failure:
- Acute renal failure (ARF) can stem from diseases of pre-renal (severe bleeding, hypovolemia, extensive burns, renal hypoperfusion, heart failure, liver cirrhosis, etc.), intrinsic renal (the glomeruli, the tubules, the interstitium, and/or the renal blood vessels), and post-renal systems (obstructive uropathy arising from blood clots, tumors, or congenital defects)  . Patients in the intensive care unit who are critically ill are most susceptible to ARF  , who present with symptoms of shock due to the severe effects of hyperkalemia, metabolic acidosis and diminished glomerular filtration rate (GFR) .
- Chronic renal failure - Contrary to ARF, a slowly progressing course of symptoms is seen in chronic renal impairment. At first, patients may be completely asymptomatic, but signs such as alterations in urinary habits (nocturia), generalized weakness, and fatigue eventually ensue  . As chronic renal failure is an irreversible and progressive process, further deterioration of kidney function leads to neuromuscular symptoms (hyperreflexia, cramping, neuropathies, or even convulsions), weight loss, nausea, pruritus, and anorexia  . The last stage of chronic renal failure, termed end-stage renal disease (ESRD), can include all of the mentioned symptoms, as well as muscle wasting, depression, anxiety, constipation, sleep disturbances, restless legs, and dyspnea   .
Entire Body System
Management of pain in the elderly is very challenging. [ncbi.nlm.nih.gov]
The clinical presentation ranges from asymptomatic to life-threatening shock, depending on the severity of impairment. [symptoma.com]
The 5-day asymptomatic period would allow sufficient time for the drug to accumulate and the extended period seen after its cessation would be seen in a dose-dependent side effect. [ncbi.nlm.nih.gov]
It is usually asymptomatic but uncommonly may cause lower back pain, with a frequency of about 1-2.5% 4. The underlying etiology is believed to be mechanical stress across the sacroiliac joint. [radiopaedia.org]
- Weight Gain
Case two A 50-year-old man presented with indigestion, abdominal bloating, weight gain, dry skin and lethargy. His past medical history included laminectomy and longstanding tobacco use. [academic.oup.com]
You may need to reduce your calorie intake, since the sugar in the dialysate may cause weight gain. Hemodialysis. Hemodialysis can be performed at home or in a dialysis center or hospital by trained health care professionals. [hopkinsmedicine.org]
gain 1 2 1 1 Table 4. [hyper.ahajournals.org]
- Short Stature
Therefore, children with CKD are at risk for short stature, bone curvature, and poor mineralization (“renal rickets” is the equivalent term for adult osteomalacia). [emedicine.medscape.com]
- Intravenous Administration
Unfortunately, the evidence of long-term antibiotics in osteitis is even more scarce: its advocates use the example of long bone osteomyelitis, to suggest that intravenous administration of antibiotics can produce high enough levels in the bone to clear [journals.lww.com]
The most common adverse events (AEs) in all renal function categories were gastrointestinal (GI), predominantly nausea and vomiting. [ncbi.nlm.nih.gov]
As chronic renal failure is an irreversible and progressive process, further deterioration of kidney function leads to neuromuscular symptoms (hyperreflexia, cramping, neuropathies, or even convulsions), weight loss, nausea, pruritus, and anorexia. [symptoma.com]
Other symptoms of acute tubular necrosis include tiredness, swelling, lethargy, nausea, vomiting, abdominal pain, kidney pain, loss of appetite, and rash. Sometimes there are no symptoms. [emedicinehealth.com]
- Heart Failure
European Journal of Heart Failure © 2016 European Society of Cardiology. [ncbi.nlm.nih.gov]
(severe bleeding, hypovolemia, extensive burns, renal hypoperfusion, heart failure, liver cirrhosis, etc.), intrinsic renal (the glomeruli, the tubules, the interstitium, and/or the renal blood vessels), and post-renal systems (obstructive uropathy arising [symptoma.com]
This may mean treating a health problem like heart failure, taking you off certain medications, or giving you fluids through an IV if you’re dehydrated. Medications. [m.webmd.com]
- Heart Disease
Prevention of heart disease, stroke and vascular disease People with kidney disease are at greatly increased risk of heart disease, stroke and problems with the circulation. [edren.org]
Approximately 75% of patients with T2DM also have hypertension, 4 which increases the risk for cardiovascular (CV) events. 5 Coronary heart disease (CHD) is common in patients with T2DM; heart disease was noted on 68% of diabetes-related death certificates [clinicaladvisor.com]
Cornfield J (1962) Joint dependence of risk of coronary heart disease on serum cholesterol and systolic blood pressure: a discriminant function analysis. Fed Proc 21:58–61 PubMed Google Scholar 3. [link.springer.com]
[…] condition such as diabetes, heart disease, hypertension, liver disease, or obesity Getting heart surgery or a bone marrow transplant ESRD Compared to CKD Reaching end-stage renal disease means that the patient will no longer be able to survive without [availclinical.com]
Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as: DO NOT smoke. Eat meals that are low in fat and cholesterol. Get regular exercise (talk to your doctor or nurse before starting to exercise). [nlm.nih.gov]
The renal impairment group showed more advanced age of onset, higher percentage of prior stroke and hypertension, higher baseline National Institute of Health Stroke Scale score, lower high-density lipoprotein cholesterol levels, and higher Hcy levels [ncbi.nlm.nih.gov]
New PFJ (1977) Computed tomography in the diagnosis of haemorrhagic stroke. In: Thompson RA, Green J (eds) Advances in neurology. Raven Press, New York, pp 145–168 Google Scholar 15. [link.springer.com]
At first, patients may be completely asymptomatic, but signs such as alterations in urinary habits (nocturia), generalized weakness, and fatigue eventually ensue. [symptoma.com]
Symptoms of ESRD include: 1 nocturia malaise anorexia/nausea/vomiting pruritus restless legs dyspnoea Patients with acute renal failure from glomerulonephritis caused by viral infection and immune reaction can present with proteinuria and “nephritic sediment [myhivclinic.org]
Nocturia is often noted, principally due to failure to concentrate the urine. Lassitude, fatigue, anorexia, and decreased mental acuity often are the earliest manifestations of uremia. [merckmanuals.com]
Chronic Kidney Disease Symptoms Effects and symptoms of chronic kidney disease include: need to urinate frequently, especially at night (nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood pressure; fatigue and [emedicinehealth.com]
- Renal Function Decreased
INTRODUCTION: The glomerular filtration rate (GFR), a measure of renal function, decreases by approximately 10 mL/min every 10 years after the age of 40 years, which could lead to the accumulation of drugs and/or renal toxicity. [ncbi.nlm.nih.gov]
Renal impairment, both in the form of acute and chronic renal failure, could be severely harmful and even life-threatening for the patient in the absence of an early diagnosis . For this reason, physicians must obtain a thorough patient history and determine the presence of underlying disorders that may induce renal impairment, whereas a complete physical examination assesses the signs and symptoms and determine the next steps in workup . In fact, the clinical examination can lead to a prompt diagnosis in some cases, examples being prostate hypertrophy and cervical cancer, where the physician might be able to palpate the masses during rectal and vaginal examinations, respectively . As soon as a presumptive diagnosis is made, a meticulous laboratory workup needs to be performed. A complete blood count (CBC), kidney function tests (urea and creatinine), urinalysis, serum glucose levels, complete coagulation panel, serum electrolytes (sodium, potassium, bicarbonate, calcium, and phosphate), inflammatory parameters (erythrocyte sedimentation rate, C-reactive protein), liver transaminases, and in most severe patients, arterial blood gasses must be included   . Imaging studies are equally important in determining the cause of kidney failure, with abdominal ultrasonography being the gold standard for evaluation of kidney anatomy and structure  . To assess the degree of kidney failure, determination of GFR using creatinine and specific calculations is vital in establishing the severity of renal impairment  .
hemoglobin, and HbA 1c ), albuminuria was the strongest predictor of kidney disease. [clinicaladvisor.com]
Stage 1 – a normal eGFR greater than or equal to 90 millilitres per minute per 1.73m 2, and albuminuria, haematuria, a pathological abnormality or a structural abnormality. [kidney.org.au]
In addition, some DPP-4 inhibitors have been shown to reduce albuminuria, an indicator of glomerular dysfunction. Consideration of this information is useful in informing optimal management strategies for patients with T2DM and concomitant CKD. [ncbi.nlm.nih.gov]
Effects of different ACE inhibitor combinations on albuminuria: results of the GUARD study. Kidney Int 2008;73:1303–9. Upadhyay A, Earley A, Haynes SM, Uhlig K. [racgp.org.au]
*Markers of kidney disease may include: albuminuria (ACR > 3 mg/mmol), haematuria (or presumed or confirmed renal origin), electrolyte abnormalities due to tubular disorders, renal histological abnormalities, structural abnormalities detected by imaging [renal.org]
- Abnormal Renal Function
[…] of CKD in the general population and the prevalence of these conditions is increasing in HIV-infected people. 5 Abnormal renal function has been shown to be an independent predictor of mortality in people living with HIV (PLWHIV). 6 The higher prevalence [myhivclinic.org]
Both have low urine concentrations and are not indicated in the treatment of UTI in patients with normal or abnormal renal function. In contrast, ciprofloxacin and levofloxacin achieve high urine concentrations with oral or parenteral therapy. [cjasn.asnjournals.org]
Background There is a high prevalence (30%) of abnormal renal function among patients with HIV disease. CKD is increasingly a cause of morbidity among people with HIV infection. [hiv.va.gov]
The patient reported a personal history of dyslipidemia, type 2 diabetes mellitus, arterial hypertension, grade I obesity, and renal colic with calcium oxalate stones. [elsevier.es]
Screen for and/or maximize treatment for diabetes and dyslipidemia (see Diabetes and Dyslipidemia. Screen for and treat hematologic abnormalities (eg, anemia). [hiv.va.gov]
Dyslipidemia should be addressed. Dietary modification may be helpful for hypertriglyceridemia. Statins are effective for hypercholesterolemia. [merckmanuals.com]
The patient presented with acute confusion, muscle cramps and myoclonic jerks 5 weeks after treatment. [ncbi.nlm.nih.gov]
As renal dysfunction may impact the clinical management of multiple myeloma and is associated with poor prognosis, the preservation of renal function is critical, warranting non-nephrotoxic alternatives where possible in managing this population. © 2017 [ncbi.nlm.nih.gov]
Treatment and prognosis It carries a benign prognosis and may even resolve spontaneously. The main differential diagnosis is a sacroiliitis. [radiopaedia.org]
An accurate history and careful examination will determine the sequence and spectrum of clinical investigations required to make a diagnosis or decide on prognosis or treatment. [oxfordmedicine.com]
This unusual clinical course is useful for further analysis of the etiology of TAFRO syndrome. [ncbi.nlm.nih.gov]
Introduction Osteitis condensans ilii (OCI) is one of the benign etiologies of chronic axial low back pain. Most of the time, OCI is an incidental finding on plain X-ray with ileal sclerosis. [cureus.com]
The underlying etiology is believed to be mechanical stress across the sacroiliac joint. Supporting this hypothesis, it is most often seen in women who have given birth; however, men and nulliparous women can be affected 2-4. [radiopaedia.org]
[…] consequences of renal cyclooxygenase-2 (COX-2) inhibition, the reported cases should draw the attention of doctors and patients to the importance of recognizing any possible signs of renal impairment during nimesulide therapy, although only extensive epidemiological [ncbi.nlm.nih.gov]
Diabetic retinopathy results in up to 24,000 new cases of blindness annually in the United States and is the leading cause of new cases of blindness in adults. 4 Neuropathy due to DM occurs in 60% to 70% of patients with T2DM. 4 Epidemiology of CKD/RI [clinicaladvisor.com]
Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention [revistanefrologia.com]
Several studies have described the pathophysiology of diminished renal function in hypothyroidism. Few studies or case reports have shown total amelioration of renal impairment as seen in our patient. [ncbi.nlm.nih.gov]
[…] kidney disease (CKD), caused directly or indirectly by HIV and/or due to drug-related effects. 1 ARF may be associated with antiretroviral therapy (ART), or treatment for HIV- associated opportunistic infections. 1 CKD disease can be caused by multiple pathophysiological [myhivclinic.org]
Whilst the pathophysiology of impaired renal function in hypothyroidism is multifactorial, the reduction in GFR due to the lower cardiac output and renal blood flow is likely to be the predominant mechanism [ 3 ]. [academic.oup.com]
Still, the pathophysiology of OCI is not clearly understood, but the increased mechanical stress on ileum is considered one of the causative factor of OCI in pregnant women. [cureus.com]
Kidney Diseases Precautions for Healthy Person Precautions for Kidney Patients Prevention of Acute Kidney Failure Prevention of Polycystic Kidney Disease Precautions for Single Kidney Patients Prevention of Kidney Stone Disease Prevention of Urinary [kidneyeducation.com]
Recognition of this unusual finding, and features distinguishing it from other causes of high CSF signal intensity, such as subarachnoid haemorrhage and protein in the CSF, are emphasised to help prevent diagnostic errors. [ncbi.nlm.nih.gov]
- Fry AC, Farrington K. Management of acute renal failure. Postgrad Med J. 2006;82(964):106-116.
- Hilton R. Acute renal failure. BMJ : British Medical Journal. 2006;333(7572):786-790.
- Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004;114(1):5-14.
- Parmar MS. Chronic renal disease. BMJ. 2002;325(7355):85-90.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007;14(1):82-99.