Renal Failure Question (Infections)

[BAM!]

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why do renal failure patients get infections? is there some physiologic explanation?

thx

 

[Rendar5]

why do renal failure patients get infections? is there some physiologic explanation?

thx

what type of renal failure do you mean, are you talking on HD or post-transplant, and what type of infections?

 

[The Angriest Bird]

1. renal failure --> uremia --> impaired immunity (i don't think the exact pathophysiology is well understood)

2. if the renal failure is secondary to DM, we know that neutrophils stop functioning when blood sugar is above 200

3. renal failure patients usually have a bunch of comorbidities

 

[tfom08]

The above answer is good. Also they tend to have poor nutritional status. Some of them with have HD caths in for extended periods. If they are transplant patients, they are immunosuppressed with cyclosporine or tacrolimus along with mycophenolate mofetil and maybe prednisone.

 

[ubcredfox]

Renal failure, like hepatic failure, should always be thought of as a state of gross physiological disturbance. Undoubtedly, varying degrees of immune dysregulation occur in both.

Any dysregulation or renal function on the spectrum of azotemia to frank uremia will involve immunosuppression. This can be very significant, as one can see an increased propensity to opportunistic infections and even opportunisitic neoplasms (for instance squamous carcinoma).

I tend to treat all patients with renal dysregulation rather aggressively when it comes to any sort of infection. Oh, and remember that an important corollary of having a poor immune system is that infectious disease tends to present later, more aggressively yet with subtler clinical features.

 

[BAM!]

1. renal failure --> uremia --> impaired immunity (i don't think the exact pathophysiology is well understood)

2. if the renal failure is secondary to DM, we know that neutrophils stop functioning when blood sugar is above 200

3. renal failure patients usually have a bunch of comorbidities

thanks for all the responses. i feel a little like i can't get past that medical emperical leap of faith that skips all the important steps. I guess my question is, why does uremia lead to impaired immunity? even if the pathophys isn't well understood, any ideas?

 

[ubcredfox]

When most people think of uremia they think of a high creatinine and BUN. What you have to remember is that these are simply markers; in reality there are like tens (if not hundreds) of thousands of molecules whose clearance is being impaired. Amongst them must be cytotoxins of varying kinds. Additionally, the perturbation of plasma composition likely leads to enzyme dysregulation, and ion gradient perturbations that would affect cellular function. A really good example of this is platelets - all uremic patients are at risk of bleeding diathesis. I'm sure there are other things going on as well..but that's my quick 2c.

 

[jdh71]

why do renal failure patients get infections? is there some physiologic explanation?

thx

most renal failure patients are diabetics - all you need to know

 

[jdh71]

thanks for all the responses. i feel a little like i can't get past that medical emperical leap of faith that skips all the important steps. I guess my question is, why does uremia lead to impaired immunity? even if the pathophys isn't well understood, any ideas?

go to pubmed, do a search, nothing ground-breaking, but lots of basic science showing impairment in immune functions when uremia gets high