10.May.2016

1. DR. ASMATULLAH SAPAND
A H M A D S H A H A B D A L I
I N S T U T U T E O F H I G H E R
E D U C AT I O N
D E PA R T M E N T O F
I N T E R N A L M E D I C I N E
K H O S T - A F G H A N I S TA N

2. MANAGEMENT OF COMPLICATIONS
ENDOCRINE ABNORMALITIES:
• Amenorhea in females.
• loss of libido in both sexes(hyperprolactinemia)

3. MANAGEMENT OF COMPLICATIONS
CVS DISORDERS:
• Hypertension(80%)
• Atherosclerosis
• Pericarditis

4. MANAGEMENT OF COMPLICATIONS
ACIDOSIS:
• Metabolic acidosis(irregular acid-base balance)

5. MANAGEMENT OF COMPLICATIONS
INFECTIONS:
• Both cellular and humoral immunity are impaired.
• UTI is common.

6. MANAGEMENT OF COMPLICATIONS
SKIN ABNORMALITIES:
• Pruritus
• Yellow-brown skin pigmentation.

7. MANAGEMENT OF COMPLICATIONS
NEUROMUSCULAR DISTURBANCES:
• Neuropathy:
- secondary N (paraesthesia)
- motor N (foot drop)
- autonomic (postural hypotension, GI-motility disorders)
• Myopathy: (poor nutrition, hyperparathyroidism, vit.D
deficiency, and electrolyte disturbance)

8. MANAGEMENT OF COMPLICATIONS
INDICATIONS FOR DIALYSIS IN CKD:
• Uremic symptoms (pericarditis, encephalopathy, seizures, or
coagulopathy)
• Fluid overload unresponsive to diuretics
• Refractory Hyperkalemia
• Severe metabolic acidosis (PH<7.2)
• Serum creatinine about 10mg/dl and urea 200md/dl.
• PATIENT TYPICALLY REQUIRE HEMODIALYSIS 3-
TIMES-PER-WEEK.

9. MANAGEMENT OF COMPLICATIONS
COAGULOPATHY: DUE TO PLATELET DYSFUNCTION
IN CKD, resulting in Petechiae, Purpura, and increased
tendency for bleeding during surgery.
ENCEPHALOPATHY: (GFR<10-15ml/min)
Resulting from uremia, accumulation of other toxins and
hypercalcemia(>14-15mg/dl)
HEART FAILURE: features of both right and left HF.