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.
Presentation
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) [1] [2]. Patients in the intensive care unit who are critically ill are most susceptible to ARF [1] [3], who present with symptoms of shock due to the severe effects of hyperkalemia, metabolic acidosis and diminished glomerular filtration rate (GFR) [2].
- 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 [4] [5]. 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 [4] [5]. 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 [2] [4] [6].
Entire Body System
- Pain
Management of pain in the elderly is very challenging. [ncbi.nlm.nih.gov]
- Anemia
A blood test showed thrombocytopenia, anemia, and elevated C-reactive protein, alkaline phosphatase, and creatinine levels. [ncbi.nlm.nih.gov]
Anemia is characteristic of moderate to advanced CKD (≥ stage 3). The anemia of CKD is normochromic-normocytic, with an Hct of 20 to 30% (35 to 40% in patients with polycystic kidney disease ). [merckmanuals.com]
Anemia is common with CKD. The two most common causes of anemia with kidney disease are iron deficiency and the lack of erythropoietin. [emedicinehealth.com]
Treatments include: Anemia treatment Hemoglobin is the substance in red blood cells that carries vital oxygen around the body. If hemoglobin levels are low, the patient has anemia. [medicalnewstoday.com]
[…] due to chronic kidney disease Anemia in chronic kidney dis Anemia in kidney disease Anemia of chronic renal failure Arteriolar nephrosclerosis (kidney disease) Benign arteriolar nephrosclerosis Benign hypertensive heart and chronic renal disease Benign [icd10data.com]
- Swelling
Fatigue Late Stage Ammonia breath Loss of appetite/diarrhoea Difficulty breathing Swelling Nausea/vomiting Loss of consciousness Anaemia If the kidney damage is in the early stages, it can be controlled with medication and diet. [nkfs.org]
Nephrotic syndrome is characterized by protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling. Ingestion of certain medications that may cause toxicity to the kidneys. Polycystic kidney disease. [stanfordchildrens.org]
Other symptoms include producing less urine than usual, blood in the urine, high blood pressure, and body swelling (retaining water). [emedicinehealth.com]
You may experience the following: Peeing less than normal Swelling in your legs, ankles, and feet (caused by your body holding on to fluid) Drowsiness or feeling very tired Shortness of breath Itching Joint pain, swelling Loss of appetite Confusion Throwing [m.webmd.com]
- Fatigue
Subsequently he developed polyuria, polydipsia, and fatigue with an increase in serum creatinine to 2.8 mg/dL, and random plasma glucose levels elevated to 903 mg/dL. Gatifloxacin was stopped. Intravenous regular insulin infusion was administered. [ncbi.nlm.nih.gov]
At first, patients may be completely asymptomatic, but signs such as alterations in urinary habits (nocturia), generalized weakness, and fatigue eventually ensue. [symptoma.com]
Blockage of urinary collecting system (e.g. kidney stones) Chronic infections (e.g. pyelonephritis) Rare genetic disorders (e.g. polycystic kidney disease) Early Stage No clear signs with possible bubbles/blood in urine Mid Stage Loss of appetite Swelling Fatigue [nkfs.org]
- Congestive Heart Failure
heart failure, and age. [pharmacytimes.com]
[…] and chronic kidney disease Hypertensive heart and chronic kidney disease with congestive heart failure Hypertensive heart and kidney disease Hypertensive heart and kidney disease with chf Hypertensive heart/kidney dis w/ congestive heart fail Hypertensive [icd10data.com]
Clinical congestive heart failure was noted in four patients, three of whom continued on the study after fluid adjustment, and one of whom discontinued. [nature.com]
heart failure. 26,27 The risk for CV events, including death, in both groups increases progressively with rising albuminuria and declining GFR. 28,29 Awareness of CKD/RI: clinicians There is a significant lack of awareness by many clinicians of the incidence [clinicaladvisor.com]
Respiratoric
- Dyspnea
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. [symptoma.com]
Lack of energy and pruritus are reported by up to 75 percent of patients with stage 5 chronic kidney disease. 16 More than one-half of patients have drowsiness, dyspnea, or edema 16 ; additional symptoms include dry mouth, muscle cramps, restless legs [aafp.org]
Risk factors Male sex HCV coinfection HIV viral load of >10,000 copies/mL CD4 count of Presence of an opportunistic infection History of an AIDS diagnosis Current or prior ART May be asymptomatic, or may present with volume overload (dyspnea, orthopnea [hiv.va.gov]
It is unlikely that the three reports of cough among hemodialysis patients are treatment related because there was a higher incidence of respiratory complaints (ie, dyspnea, allergic rhinitis, chronic obstructive pulmonary disease) at study entry among [hyper.ahajournals.org]
Gastrointestinal
- Vomiting
The most common adverse events (AEs) in all renal function categories were gastrointestinal (GI), predominantly nausea and vomiting. [ncbi.nlm.nih.gov]
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]
[…] abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache Stunted growth Malaise High urine output or no urine output Recurrent urinary tract infections Urinary incontinence Pale [stanfordchildrens.org]
- Loss of Appetite
[…] of appetite Swelling Fatigue Late Stage Ammonia breath Loss of appetite/diarrhoea Difficulty breathing Swelling Nausea/vomiting Loss of consciousness Anaemia If the kidney damage is in the early stages, it can be controlled with medication and diet. [nkfs.org]
[…] of Appetite Stomach Pain Headache / Migraine / Dizziness Headaches & Migraines Vertigo Kidney / Bladder / Prostate Bladder Infections / Urinary Tract Infections Prostate Disorders Mood Balancing Burnout Depression vs. [pascoe.ca]
You may experience the following: Peeing less than normal Swelling in your legs, ankles, and feet (caused by your body holding on to fluid) Drowsiness or feeling very tired Shortness of breath Itching Joint pain, swelling Loss of appetite Confusion Throwing [m.webmd.com]
- Constipation
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. [symptoma.com]
Balance Allergy Bones and Joints Arthritis Rheumatism Cardiovascular System Arrhythmias Hypertension Varicose Veins Cardiovascular Problems Common Cold and Flu Bronchitis Cold & Flu Sinusitis Sore throats Tonsillitis Gastrointestinal / Digestion / Liver Constipation [pascoe.ca]
Hyperparathyroidism itself may cause any of the following: Nausea Constipation Fatigue Frequent urination Weakness Blood tests show a high level of calcium, parathyroid hormone, and alkaline phosphatase (a bone chemical). [medlineplus.gov]
All phosphate binders may cause constipation, nausea, vomiting, bowel obstruction, and fecal impaction. Phosphate binders may interfere with the absorption of other medications if these are taken together. [emedicinehealth.com]
Jaw & Teeth
- Dysgeusia
Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia, nocturia, lassitude, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, water retention, undernutrition, peripheral neuropathies [merckmanuals.com]
Cardiovascular
- 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]
- Hypotension
Hypotension: INVOKANA ® causes intravascular volume contraction. [invokanahcp.com]
Although hypotension prompted withdrawal of two patients who were receiving therapy with losartan 50 mg, neither episode was considered severe and neither required treatment. There were no reports of first-dose hypotension or angioedema. [hyper.ahajournals.org]
[…] of the increased risk of electrocardiographic changes and medication-induced arrhythmias in renal disease due to electrolyte imbalances. 3,4 Additionally, there is case evidence 5 that phenothiazine antipsychotics could increase a patient’s risk for hypotension [mdedge.com]
Common side effects reported with TCAs include postural hypotension and anticholinergic side effects, such as constipation, urinary retention, blurred vision, dry mouth, delirium, and sedation. [the-hospitalist.org]
Skin
- Pruritus
Treatment is often ineffective and symptoms, particularly pruritus, can be severe. [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]
Adverse events included pruritus (20%), fatigue (14%), and nausea (12%). There were no serious adverse events related to the study drugs, and there were no grade 4 laboratory abnormalities reported. [hcvguidelines.org]
- Skin Rash
The signs of kidney disease are: Change in urination Swelling Fatigue Skin rash Metallic taste in mouth Nausea and/or vomiting Shortness of breath Feeling cold Dizziness Trouble concentrating High blood pressure In many cases, kidney damage is the result [davita.com]
She denied any joint stiffness, swelling, deformity, no skin rash, no eye, and bowel symptoms. She denied any weight loss. Physical examination was normal. Faber’s /Patrick’s test (flexion, abduction, external rotation of hip) was non-revealing. [cureus.com]
Hypotension prompted the early withdrawal of one patient each in groups 2 and 3, and two additional patients in group 3 were discontinued because of skin rash and dizziness, respectively. [hyper.ahajournals.org]
Common adverse drug reactions of these drugs include: Hypotension ( low blood pressure ) Cough Hyperkalemia (high potassium) Headache Dizziness Fatigue Nausea Skin rash A metallic taste in the mouth Diarrhea Indigestion Abnormal liver function Muscle [emedicinehealth.com]
The main side effects are nausea, headache, skin rash, abdominal pain, vomiting and diarrhoea. The overall incidence of these adverse effects was 16% among 4000 patients treated by fluconazole [ 5 ]. [academic.oup.com]
Musculoskeletal
- Muscle Cramp
The patient presented with acute confusion, muscle cramps and myoclonic jerks 5 weeks after treatment. [ncbi.nlm.nih.gov]
Possible complications of hemodialysis include muscle cramps and hypotension (sudden drop in blood pressure). Hypotension may cause you to feel dizzy or weak, or sick to your stomach. [hopkinsmedicine.org]
cramps or restless legs Seeing a doctor when you have stage 3 CKD As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). [davita.com]
You may notice one or more of the following symptoms if your kidneys are beginning to fail: Itching Muscle cramps Nausea and vomiting Not feeling hungry Swelling in your feet and ankles Too much urine (pee) or not enough urine Trouble catching your breath [kidneyfund.org]
However, you may notice that you: feel more tired and have less energy have trouble concentrating have a poor appetite have trouble sleeping have muscle cramping at night have swollen feet and ankles have puffiness around your eyes, especially in the [kidney.org]
- Osteoporosis
Denosumab is an emerging new treatment for osteoporosis in postmenopausal women and men with non-metastatic prostate cancer. [ncbi.nlm.nih.gov]
Article date: April 2010 Zoledronic acid 5 mg for infusion (Aclasta▼) is used for the once-yearly treatment of osteoporosis in patients at increased risk of fracture, and as a single dose for the treatment of Paget’s disease of the bone. [gov.uk]
People with hyperparathyroidism are more likely to have osteopenia (thin bones) or osteoporosis (very thin bones) than to have full-blown osteitis fibrosa. [medlineplus.gov]
It is the definitive treatment option for all patients with symptomatic primary HPT or associated with osteoporosis. [hindawi.com]
Fluoride and osteoporosis. Proceedings of the Society for Experimental Biology and Medicine 191: 278-86. [fluoridealert.org]
- Muscle Weakness
HCTZ) are commonly given as a first-line treatment of essential hypertension but do have several known side effects, including skeletal muscle weakness, potentiation of non-depolarizing NMBDs, and the possibility of digitalis toxicity. [ Brater DC. ]. [openanesthesia.org]
Neurologic
- Confusion
The patient presented with acute confusion, muscle cramps and myoclonic jerks 5 weeks after treatment. [ncbi.nlm.nih.gov]
You may experience the following: Peeing less than normal Swelling in your legs, ankles, and feet (caused by your body holding on to fluid) Drowsiness or feeling very tired Shortness of breath Itching Joint pain, swelling Loss of appetite Confusion Throwing [m.webmd.com]
- Headache
/ Migraine / Dizziness Headaches & Migraines Vertigo Kidney / Bladder / Prostate Bladder Infections / Urinary Tract Infections Prostate Disorders Mood Balancing Burnout Depression vs. [pascoe.ca]
[…] infection Pale skin History of taking certain medications History of trauma Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache [stanfordchildrens.org]
Specifically, using VAS to assess headache, there was no correlation between osteitis severity and headache [13▪]. [journals.lww.com]
Symptoms of kidney disease can include: tiredness loss of appetite difficulty sleeping headaches lack of concentration shortness of breath nausea and vomiting changes in the amount and number of times urine is passed changes in the appearance of urine [betterhealth.vic.gov.au]
[…] of trauma (a risk factor for acute renal failure) Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents (a risk factor for acute renal failure) Chronic: Poor appetite Vomiting Bone pain Headache [hopkinsmedicine.org]
- Difficulty Concentrating
concentrating, personality changes or seizures Decreased immune response, which makes you more vulnerable to infection Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium) Pregnancy complications that carry risks [mayoclinic.org]
This can result in: Feeling tired or weak Memory problems Difficulty concentrating Dizziness Low blood pressure Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. [en.wikipedia.org]
Urogenital
- Kidney 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 [symptoma.com]
In some cases, the patient may develop end-stage kidney failure, which can be fatal. What Causes Kidney Failure? The effective treatment of someone with chronic kidney disease will depend on the ability to address the underlying issues. [availclinical.com]
This type of kidney failure is called acute kidney injury or acute renal failure. [kidneyfund.org]
- Renal Insufficiency
Abstract Renal insufficiency is associated with the prognosis of acute ischemic stroke (AIS) and homocysteine (Hcy) levels. This study investigated the association between plasma Hcy levels and renal insufficiency in patients with AIS. [ncbi.nlm.nih.gov]
Of the subset of 11 patients in whom clearance studies for GFR and ERPF were performed, 5 were in the mild renal insufficiency group and 6 were in the moderate to severe renal insufficiency group. [hyper.ahajournals.org]
What is renal insufficiency? Renal insufficiency is poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys caused by renal artery disease. [ucdmc.ucdavis.edu]
- Nocturia
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]
- Oliguria
Increased intra-abdominal pressure during laparoscopy can mimic an abdominal compartment syndrome, compressing the kidneys (retroperitoneal) and resulting in oliguria. Aortic cross clamping is dangerous, regardless of where it occurs. [openanesthesia.org]
"Acute Oliguria". New England Journal of Medicine. 338 (10): 671–75. doi : 10.1056/NEJM199803053381007. [en.wikipedia.org]
[…] kidneys May be AKI or some forms of CKD ( diabetic nephropathy, acute hypertensive nephrosclerosis, polycystic kidney disease, myeloma, rapidly progressive glomerulonephritis, infiltrative diseases [eg, lymphoma, leukemia, amyloidosis ], obstruction) Oliguria [merckmanuals.com]
[…] with kidney disease, such as: decreased attentiveness, nausea, vomiting, anorexia, weight change, dyspnea, orthopnea, leg swelling, fatigue, muscle cramps, restless legs, peripheral neuropathy, pruritus, urinary urgency or frequency, nocturia, dysuria, oliguria [hiv.va.gov]
- 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]
Workup
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 [1]. 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 [2]. 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 [1]. 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 [1] [2] [5]. 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 [1] [5]. To assess the degree of kidney failure, determination of GFR using creatinine and specific calculations is vital in establishing the severity of renal impairment [1] [5].
X-Ray
- Nephrolithiasis
Nephrolithiasis Renal colic, dysuria, urgency; mild ↑ Cr; crystals on UA; stones or filling defects on radiography Risk reduced by drinking 1.5-2 liters of liquids per day. [hiv.va.gov]
Discussion Before the 1970s, the presentation of HPT was characterized by recurrent nephrolithiasis, brown tumors, neuromuscular dysfunction, symptomatic hypercalcemia, peptic ulcer disease, psychosis, and pancreatitis [2]. [hindawi.com]
Alternatively, the risk might be increased by disease factors ( e.g., papillary necrosis, nephrolithiasis, neurogenic bladder) and the management of comorbidities with Foley catheters and intravenous lines. [cjasn.asnjournals.org]
Control of underlying disorders Possible restriction of dietary protein, phosphate, and potassium Vitamin D supplements Treatment of anemia Treatment of contributing comorbidities (eg, heart failure, diabetes mellitus, nephrolithiasis, prostatic hypertrophy [merckmanuals.com]
Serum
- Thrombocytopenia
A blood test showed thrombocytopenia, anemia, and elevated C-reactive protein, alkaline phosphatase, and creatinine levels. [ncbi.nlm.nih.gov]
Most Grade 3/4 AEs were hematologic, including anemia (28.0%), thrombocytopenia (20.0%) and lymphopenia (18.0%) ( Table 5 ). [nature.com]
LMWHs have a more predictable anticoagulant response, improved subcutaneous bioavailability, dose-independent clearance, longer biological half-life, and a lower incidence of thrombocytopenia. 2 Elimination of LMWHs also differs from UFH in that LMWHs [ptcommunity.com]
Patients with severe RI experienced an increased incidence of thrombocytopenia, required more frequent lenalidomide dose reductions or interruptions, and had shorter OS than those without RI. [jco.ascopubs.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]
- Hyperuricemia
BACKGROUND AND OBJECTIVE: Verinurad (RDEA3170) is a high-affinity, selective URAT1 transporter inhibitor in development for treating gout and asymptomatic hyperuricemia. [ncbi.nlm.nih.gov]
PATHOPHYSIOLOGY OF RI IN MYELOMA Section: RI in MM results primarily from the toxic effects of monoclonal light chains on the kidney, as well as other contributing factors, such as dehydration, hypercalcemia, hyperuricemia, the use of nephrotoxic drugs [jco.ascopubs.org]
Treatment
The patient presented with acute confusion, muscle cramps and myoclonic jerks 5 weeks after treatment. [ncbi.nlm.nih.gov]
Prognosis
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]
Etiology
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]
Epidemiology
[…] 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]
Pathophysiology
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]
Prevention
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]
References
- 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.