Specimen Name Result Units Range
Plasma Sodium 133 mmol/L (135-145)
Potassium 5.0 mmol/L (3.5-5.5)
Chloride 101 mmol/L (100-109)
Bicarbonate 15 mmol/L (22-32)
Anion Gap 22 mmol/L (7-17)
Glucose 8.4 mmol/L (3.8-5.5)
Urea 35 mmol/L (2.7-7.2)
Creatinine 950 μmol/L (60-110)
Phosphate 1.69 mmol/L (0.80-1.45)
Total Calcium 2.80 mmol/L (2.10-2.55)
Albumin 36 g/L (34-48)

66yo male known to RAH.
Chronic Renal Failure

 

Common Causes:

  • diabetic nephropathy ≈ 28%
  • hypertension ≈ 24%
  • glomerulonephritis ≈ 21%
  • polycystic kidney disease
  • Fabry disease, lupus nephritis, analgesic nephropathy, etc.

 

Clinical Features:

  1. those corrected by dialysis
    • fluids & electrolytes:
      • H2O, volume
      • Na+, K+, Ca++, PO4
      • acid-base
      • uraemia
      • glucose intolerance
    • hypothermia, fatigue, lethargy
    • asterixis, muscle irritability, myoclonus, coma
    • CCF, pericarditis, uraemic lung
    • anorexia, nausea, vomiting, gastroenteritis
    • coagulopathy, platelet dysfunction
  2. those relatively unchanged by dialysis
    • renal osteodystrophy, 2° hyperparathyroidism
    • hyperuricaemia, hyperlipidaemia
    • protein, calorie malnutrition
    • growth and sexual dysfunction
    • peripheral neuropathy
    • paralysis, seizures
    • accelerated atherosclerosis
    • hypertension, cardiomyopathy
    • pallor, pruritus, ecchymoses
    • anaemia, lymphopaenia, immunosuppression
    • peptic ulcers
    • splenomegaly, hypersplenism
    • restless leg syndrome
  3. those exaccerbated by dialysis
    • hypotension
    • muscle cramps
    • disequilibrium syndrome (cerebral oedema)
    • dialysis dementia ? aluminium toxicity from older filters
    • atherosclerosis
    • GIT haemorrhage
    • hepatitis, ascites
    • neutropaenia, low complement

Retained metabolites:

  • urea - probably only a "marker" in CRF
  • polypeptide "middle molecules" - MW's ≈ 300-3500
  • guanine derivatives
    • guanidine, methyl/dimethyl-guanidine
    • guanidosuccinic acid
    • creatine, creatinine
  • nucleotide metabolites
  • aromatic amino acid derivatives - tryptophan, tyrosine, phenylalanine
  • aliphatic amines
  • elevated hormone levels - PTH, glucagon, insulin GH, LH, PRL