Kidney disease experts tell children the symptoms of various organs during uremia.2017-01-24 14:28
Kidney disease experts tell children the symptoms of various organs during uremia.
In general, in uremia, children in addition to water, electrolyte, acid-base balance disorders, anemia, bleeding tendency, hypertension aggravated performance, a series of symptoms will appear in the organ system dysfunction and metabolic disorder caused by, its specific performance is as follows.
(a) nervous system symptoms
The symptoms of nervous system are the main symptoms of uremia. In the early stage of uremia, children often have dizziness, headache, fatigue, comprehension and memory loss and other symptoms. With the aggravation of the disease can appear irritability, muscle twitching, TiC; finally can develop to the expression indifferent, lethargy and coma. The occurrence of these symptoms is related to the following factors:
Accumulation of certain toxic substances may cause degeneration of nerve cells;
Electrolyte and acid-base disturbance;
Renal hypertension caused by cerebral vasospasm, hypoxia and increased capillary permeability, can cause brain cell degeneration and brain edema.
(two) the symptoms of digestive system
The earliest symptoms of uremia in children with digestive system is anorexia or indigestion; anorexia can exacerbations, nausea, vomiting or diarrhea. The occurrence of these symptoms may be the intestinal bacteria and urease resolve urea into ammonia, ammonia to stimulate gastrointestinal mucosal inflammation caused by multiple, superficial small ulcers and so on. Children with gastrointestinal bleeding.
In addition, nausea and vomiting are also associated with dysfunction of the central nervous system.
(three) cardiovascular system symptoms
Chronic renal failure in children with renal hypertension, acidosis, hyperkalemia, sodium and water retention, anemia and toxic substances, such as the role of heart failure, arrhythmia and myocardial damage, etc.. Because urea (possibly uric acid) stimulation effect, can also have sterile pericarditis in children with precordial pain; physical examination time and pericardial friction sound. In severe cases, the presence of fibrin and bloody exudate.
(four) respiratory symptoms
Acid poisoning in children with slow and deep breathing, severe acidosis can be seen when the specificity of Kussmaul breathing. The exhaled breath of children has a taste of urine, which is caused by the decomposition of urea in the saliva by bacteria. Children may appear serious pulmonary edema, fibrinous pleuritis or calcification of lung disease, related to heart failure, pulmonary edema and hypoproteinemia, sodium and water retention factors. Fibrinous pleurisy is urea stimulation induced inflammation; pulmonary calcification is caused by deposition of calcium phosphate in lung tissue.
(five) skin symptoms
Pruritus is common in children with symptoms of uremia, may be caused by the toxic product to the skin feeling is exciting; some people think it with secondary hyperparathyroidism, because after parathyroidectomy, the pain relieved immediately. In addition, children with dry skin, desquamation and yellowish brown. Changes in skin color, previously thought to be the reason for the increase in urine pigment, but with absorption spectrophotometer to check that the main pigment of the skin melanin. In the exposed parts of the skin, slight contusion can cause skin ecchymosis. Because of containing high concentrations of urea in sweat, thus opening a white crystalline urea in the sweat glands, it is called urea cream.
(six) substance metabolism disorder
1, decreased glucose tolerance
Impaired glucose tolerance in uremic patients was similar to that in patients with mild diabetes, but this change was not sensitive to exogenous insulin. The mechanism of impaired glucose tolerance may be:
Decreased insulin secretion;
Because of the increase of the basal level of growth hormone secretion, the role of insulin is strengthened;
Insulin binding to the target cell receptor, the role of insulin has weakened;
The related liver glycogen synthase activity reduced disorders caused liver glycogen synthesis.
At present, it is believed that the main causes of these changes may be the toxic effects of urea, creatinine and medium molecular weight toxins.
2, negative nitrogen balance
The negative nitrogen balance in children can cause weight loss, cachexia and hypoalbuminemia. Hypoalbuminemia is one of the important causes of renal edema. Factors that cause negative nitrogen balance:
The children with protein intake restriction or because of anorexia, nausea and vomiting caused by reduced protein intake;
Some substances such as methyl guanidine can enhance the catabolism of tissue proteins;
The combination of infection can lead to protein degradation;
For bleeding caused loss of protein;
With the loss of a certain amount of urinary protein.
A large number of urea from the blood into the intestinal cavity. Enteric bacteria can break down the urea and release ammonia, ammonia transported to the liver by the blood, the urea can be synthesized, but also the synthesis of non essential amino acids, which is beneficial to the body. So some people think that children with uremia protein intake can be lower than that of normal people, even less than 20g per day to maintain nitrogen balance, but must be given a higher nutritional value of protein, which contains essential nutrients rich amino acid. In recent years, some people believe that in order to maintain nitrogen balance in uremic patients, protein intake should be no significant difference between normal people; and that, in order to reduce the pursuit of pure blood urea nitrogen and over limit the intake of protein, the protein itself consumes too much, so it is harmful for children.
Uremia patients mainly due to the synthesis of triglycerides in the liver