Uncommon complications of renal failure

摘要

Uremia is a systemic inflammatory disease that affects many extrarenal organ systems. As advances in therapy become available, survival of uremic patients is prolonged, allowing secondary manifestations to become apparent and to require attention. Some of the uncommon manifestations are reviewed here; more widely recognized conditions (such as hypertension, anemia, renal osteodystrophy) will not be discussed. Uremic pneumonitis is a condition of the lungs characterized by a high protein exudate inthe alveoli in uremic patients. It has many features in common with adult respiratory distress syndrome (ARDS). Radiographic findings include a diffuse interstitial to alveolar pattern. Characteristic histologic changes include interstitial and alveolaredema, atelectasis, alveolar hemorrhage, and hyaline membranes. The incidence of uremic pneumonitis in dogs and cats is unknown, as is prognosis, due to difficulties in antemortem diagnosis. In one study of 10 dogs with uremic pneumonitis, all died within six days of examination, but as cases were procured from necropsy records, this is not an accurate assessment of mortality associated with the condition. There is significant overlap in clinical and radiographic signs of pulmonary edema and uremic pneumonitis, and patients with oliguric or anuric acute renal failure are predisposed to both. Pulmonary edema from volume overload can be treated with diuretics or ultrafiltration via hemodialysis if there is no response to diuretics. There is no known therapy for uremic pneumonitis except to control the uremia.