Which among the following is not seen in Chronic Renal Failure?
Correct Answer: Hypercalcemia
Description: ANSWER: (C) HypercalcemiaREF: Harrisons Internal Medicine 17th edition Chapter 274 Table 274-3 & Figure 274-1, CMDT 2009 edition Chapter 22 Kidney Disease"Hypocalcemia not hypercalcemia is seen in CRF"The disorders of calcium, phosphorus, and bone are newly referred to as mineral bone disorders of chronic kidney disease (see illustration). The most common disorder is osteitis fibrosa cystica-- the bony changes of secondary hyperparathyroidism. This affects ~ 50% of patients nearing ESRD. As GFR decreases below 25% of normal, phosphorus excretion is impaired. Hyperphosphatemia leads to hypocalcemia, stimulating secretion of PTH, which has a phosphaturic effect and normalizes serum phosphorus. This continuous process leads to markedly elevated PTH levelsand high bone turnover with osteoclastic bone resorption and subperiosteal lesions. Metastatic calcifications, such as tumoral calcinosis, can occur. Radiographically, lesions are most prominent in the phalanges and lateral ends of the clavicles.Calciphylaxis is a syndrome of vascular calcification, thrombosis and skin necrosis. It is seen almost exclusively in patients with Stage 5 chronic kidney disease. It results in chronic non-healing wounds and is usually fatal. Calciphylaxis is a rare but serious disease.Calciphylaxis is one type of extraskeletal calcification. Similar extraskeletal calcifications are observed in some patients with hypercalcaemic states, including patients with milk alkali syndrome, sarcoidosis, primary hyperparathyroidism, and hyper vitamin osis DCLINICAL AND LABORATORY MANIFESTATIONS OF CHRONIC KIDNEY DISEASE AND UREMIA:Fluid and electrolyte disturbancesVolume expansion (I)Hyponatremia (I)Hyperkalemia (I)Hyperphosphatemia (I)Cardiovascular and pulmonary disturbancesArterial hypertension (I or P)Congestive heart failure or pulmonary edema (I)Pericarditis (I)Hypertrophic or dilated cardiomyopathy (If Pf or D)Dermatologic disturbancesPallor (I)bHyperpigmentation (I, P, or D)Pruritus (P)Ecchymoses (I)Nephrogenic fibrosing dermopathy (D)Uremic frost (I)Uremic lung (I)Accelerated atherosclerosis (P or D) Hypotension and arrhythmias (D) Vascular calcification (P or D)Endocrine-metabolic disturbancesSecondary hyperparathyroidism (I or P)Adynamic bone (D)Vitamin D-deficient osteomalacia (I) Carbohydrate resistance (I)Hyperuricemia (I or P)Hypertriglyceridemia (I or P)Increased Lp(a) level (P)Decreased high-density lipoprotein level (P)Protein-energy malnutrition (I or P)Impaired growth and development (P)Infertility and sexual dysfunction (P)Amenorrhea (I/P)b-Microglobulin associated amyloidosis (P or D)Neuromuscular disturbancesFatigue (I)"Sleep disorders (P)Headache (P)Impaired mentation (I)- Lethargy (I)*Asterixis (I)Muscular irritability Peripheral neuropathy (I or P) Restless legs syndrome (I or P) Myoclonus (l)Seizures (I or P)Coma (I)Muscle cramps (P or D)Dialysis disequilibrium syndrome (D) Myopathy (P or D)Gastrointestinal disturbancesAnorexia (I)Nausea and vomiting (I)Gastroenteritis (I)Peptic ulcer (I or P)Gastrointestinal bleeding (I, P, or D)Idiopathic ascites (D)Peritonitis (D)Hematologic and immunologic disturbancesAnemia (I)bLymphocytopenia (P)Bleeding diathesis (I or D)bIncreased susceptibility to infection (I or P)Leukopenia (D)Thrombocytopenia (D)(I) denotes an abnormality that usually improves with an optimal program of dialysis and related therapy;(P) denotes an abnormality that tends to persist or even progress, despite an optimal program;(D) denotes an abnormality that develops only after initiation of dialysis therapy Improves with dialysis and erythropoietin therapy.
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