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Hyperphosphatemia of Renal FailureHyperphosphatemia of Renal Failure – General InformationHyperphosphatemia of Renal Failure is considered an electrolyte medical disorder which triggers an elevated level of phosphate in the patient’s blood. Usually, the calcium amounts are decreased, causing hypocalcemia, because of the precipitation of phosphate with the calcium in the tissues. In most cases, the medical condition is caused by the lack of the hormone which is supposed to inhibit the renal reabsorbing of phosphate, but it can also be caused by renal deficiencies or renal failure. Generally, the increased amounts of phosphate in the blood can be decreased to normal levels by administrating phosphate binders or dietary recommendations. There are cases in which the Hyperphosphatemia of Renal Failure can be treated by administrating sodium phosphate solution, taken orally, prescribed for bowel preparation before the colonoscopy procedure in children. The most common signs and symptoms caused by the condition can include ectopic calcification, secondary hyperparathyroidism and renal osteodystrophy. The condition is considered an asymptomatic disorder. The morbidity rate of Hyperphosphatemia of Renal Failure is most commonly associated with the condition that caused it, than with the disease itself. If the disease is left untreated or is treated improperly, it can progress causing more severe complications such as hypocalcemia with tetany and acute deposition of calcium or phosphate compounds in the patient’s joints, subcutaneous tissue, or other soft tissue parts of the body. There are other long term complications which can appear as dramatic, as they devastate any organ system. The most common organs that are affected by the disease can include: vascular system, bones, skin, joints and heart.Hyperphosphatemia of Renal Failure – SymptomsThe major cause of Hyperphosphatemia of Renal Failure is renal failure. There are also some other less common causes that can lead to the appearance of this kind of gastrointestinal disorder, and can be classified depending on the pathogenesis, such as increased intake, decreased output and shift from intracellular to extracellular area. The major factor that causes the disease is most frequently the impaired renal excretion with relatively increased intake and cell destruction contributing to the factor. The increased intake factors can include excessive oral and rectal administration of an oral saline laxative, such as phosphor-soda, excessive parenteral administration of phosphate, milk-alkali syndrome and vitamin D intoxication. The decreased excretion factors can include chronic and acute renal failure, hypoparathyroidism, pseudohypoparathyroidism, severe hypomagnesemia, tumoral calcinosis and bisphosphonate therapy. The shift of phosphate from intracellular to extracellular space factors can include rhabdomyolysis, tumor lysis, acute hemolysis and acute metabolic or respiratory acidosis. In most cases, the patients who suffer from Hyperphosphatemia of Renal Failure present no signs and symptoms at all. There are also cases in which the individual experiences hypocalcemic symptoms such as muscle cramps, tetany, and perioral numbness or tingling. The disease can cause signs such as bone and joint pain, pruritus, or rash. In most cases, patients experience symptoms caused by the factor that leads to the appearance of the disease and can include fatigue, shortness of breath, anorexia, nausea, vomiting, and sleep disturbances. It is very important to treat the disease in an early stage to prevent any future complications.Hyperphosphatemia of Renal Failure – TreatmentThere are there major steps to treat Hyperphosphatemia of Renal Failure and can include diagnosing the underlying cause to initiate specific treatment and enhancing renal excretion. Usually, if the cause of the disease can be determined, then the doctor can apply the available treatment options to eliminate it. In some cases, excessive ingestion of purgatives that contain phosphate or administration of excessive amounts of parenteral phosphate is very easy to treat, usually by decreasing and discontinuing the administration. In most cases, Hyperphosphatemia of Renal Failure is treated by limiting the ingested amounts of medicines and by dialysis. Due to the intestinal absorption of phosphate compounds that is unregulated and the solution prescribed as a diet is high in phosphate, it is critical to maintain a phosphate homeostasis, depending on the renal excretion of the ingested amounts. There are cases in which a simple diet recommendation, for patients who suffer with renal insufficiency or renal failure, is to avoid food high in phosphate, including dairy products. Usually, these diets are enough to control Hyperphosphatemia of Renal Failure in patients who suffer from mild renal insufficiency, but are challenging to control the patients who suffer from advanced renal insufficiency or complete renal failure. In these cases, the first step is applying a treatment trial with phosphate binders that have the effect of inhibiting gastrointestinal absorption of phosphate. There are cases in which these medicines are taken in combination with meals to act directly with the phosphate in the food, preventing the gastrointestinal absorption. There are three major phosphate binders that are mostly used by the doctors to treat Hyperphosphatemia of Renal Failure and can include aluminum binders, which are considered to cause many side effects such as dementia, chronic osteomalacia and anemia, due to toxic content of aluminum. The second major phosphate binder is the calcium binder, which can be prescribed as calcium carbonate and calcium citrate. This medicine is effective due to the mineral, calcium nutrition. The drug has also some disadvantages, such as its relatively high incidence of hypercalcemia and its contribution of large exogenous calcium amounts to the appearance of soft tissue calcification in renal failure. Most scientists consider that the calcium acetate is more effective than the sevelamer in the phosphate category. The third major phosphate binder appeared with the inefficiency of the calcium and aluminum medicines which can be prescribed as sevelamer or Renagel and lanthanum carbonate or Fosrenol. The intake of Sevelamer is the best treatment in patients who have extraskeletal calcification or recurrent hypercalcemia. The best way to treat Hyperphosphatemia of Renal Failure in patients who suffer from normal renal function is by enhancing renal excretion. This procedure is made by administrating an amount of saline solution, which can also contain loop diuretics such as furosemide and bumetanide. Another way to treat this condition is surgery, which can be applied to remove large deposits of calcium phosphate that appear in patients with tumoral calcinosis or renal failure. For patients who present complications of the disease, the first procedure is parathyroidectomy. |
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