الفهرس 
Definition of chronic renal failureOnly 14 pages are availabe for public view
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Abstract
Renal disease at any stage, from insufficiency to end-stage renal disease requiring dialysis or renal transplantation, is often accompanied by significant gastrointestinal (GI) symptoms. Conversely, patients with GI disease may present with significant renal complications. Gastrointestinal complications of CKD. include: anorexia, nausea ,vomiting, uremic fetor stomatitis, gastritis, pancreatitis as well as enteritis, on the other hand, mucosal ulcerations can occur at any level of the gastrointestinal tract and, with the bleeding tendency of uremia they account for gastrointestinal bleeding seen in untreated uremia.
Gastrointestinal bleeding is a very common complication in chronic kidney disease and is characterized by its great impact on other conditions accompanying renal failure e.g. anemia, heart failure as well as tendency to be occult in some cases, hence the ultimate need for close and proper investigations. Both upper and lower GIT endoscopy are the main stay in these patients owing to their both diagnostic and therapeutic uses.
GIT Bleeding in renal diseases can be due to: peptic ulcer with its unique features eg. lack of pain, higher tendency for bleeding and multiple ulcers. H.Pylori infection is an important risk factors for peptic ulcer. Other causes include, watermelon stomach , GIT infections with: cytomegalovirus, herpes simplex virus and clostridium difficile. Angiodysplasia is another cause of GIT bleeding in renal failure which should be kept in mind in patients with lower GIT bleeding who presents by maroon-coulored stool, melena or hematochasia. Dialysis-related amyloidosis is a disorder that commonly develops in long-term dialysis and can be another cause of gastrointestinal bleeding.
In post transplantation era, as regarding GIT bleeding, risk factors include African Americans who experience rejection, De novo systemic vasculitis after renal transplant ,Post transplantation infections as opportunistic fungal infections, post-transplantation lymphoproliferative disorder (PTLD), peptic ulceration and GIT perforations are all contributable causes.
Diagnosis of gastrointestinal bleeding in renal failure can be surprisingly difficult. This is partly due to the increased incidence of gastrointestinal angiodysplasia which can be occurred in parts not reached by the diagnostic endoscopy. The recommended investigations are:
- Occult blood in stool which is frequently positive in haemodialysed patients in the absence of overt bowel pathology.
Recently, wireless capsule endoscopy (WCE) is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.
We must be alert to the possibility of amyloidosis presenting as gastrointestinal bleeding in chronically-dialysed patients,care should be taken to obtain deeper small intestine biopsies to avoid false negative results.
The recommended treatment for GIT bleeding in chronic kidney disease should focus on the haemostatic defect that already present in these patients as well as the specific GIT pathology.