Which of the following is not seen in chronic renal failure: September 2010

Ans. C: Hypophosphatemia CKD (Chronic kidney disease) is initially without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney function decreases: Blood pressure is increased due to fluid overload and production of vasoactive hormones, increasing one's risk of developing hypeension and/or suffering from congestive hea failure. Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy). Urea is excreted by sweating and crystallizes on skin ("uremic frost"). Potassium accumulates in the blood (hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias) Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue) Fluid volume overload - symptoms may range from mild edema to life-threatening pulmonary edema Hyperphosphatemia - due to reduced phosphate excretion, associated with hypocalcemia (due to vitamin D3 deficiency). The major sign of hypocalcemia is tetany. Later this progresses to teiary hyperparathyroidism, with hypercalcaemia, renal osteodystrophy and vascular calcification that fuher impairs cardiac function. Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc.