Which of the following complications does not occur in chronic renal failure?

Appeared in: Bihar CHO -2019

Explanation

Hypercalcemia (high serum calcium) is not a typical complication of chronic renal failure (CRF).
In CRF, the kidneys fail to activate Vitamin D, which is crucial for intestinal calcium absorption. This leads to reduced calcium intake.
Simultaneously, the kidneys cannot excrete phosphate, causing hyperphosphatemia. Excess phosphate binds to calcium in the blood, further lowering the free calcium level.
The combination of decreased absorption and increased binding consistently results in hypocalcemia (low calcium), making hypercalcemia the correct answer as the condition that does not typically occur.

Option A: Hypertension is one of the most common and earliest complications of chronic renal failure. It results from sodium and water retention and over-activation of the renin-angiotensin system.
Option B: Hyperkalaemia (high potassium) is a critical and potentially lethal complication of CRF. As kidney function declines, the ability to excrete potassium is impaired, leading to its accumulation in the blood.
Option C: Hypocalcaemia (low calcium) is a classic complication of CRF. It is caused by the kidneys' inability to produce active vitamin D (calcitriol) and by high levels of phosphate (hyperphosphatemia) that bind to calcium.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Chronic Renal Failure as background academic context rather than a clinical decision trigger.
Nurses must meticulously monitor blood pressure, serum electrolytes (especially potassium), calcium, and phosphorus levels in patients with CKD.
Hyperkalemia is a medical emergency. Nurses should be able to recognize ECG changes (peaked T waves, widened QRS) and be prepared for immediate interventions like administering IV calcium gluconate, insulin with dextrose, and potassium-binding resins.
Patient education is vital, focusing on dietary restrictions for sodium, potassium, and phosphorus to manage these complications.

How to Approach the Question

First, identify that the question asks for a condition that does NOT occur in chronic renal failure (CRF). This is a negative-framing question, meaning three of the options are true complications.
Recall the primary functions of the kidneys: filtering waste, regulating fluid balance, managing electrolytes (K+, Na+, Ca++, PO4--), and producing hormones (like active Vitamin D).
Think about what happens when these functions fail:
Failure to excrete fluid and sodium leads to fluid overload and Hypertension.
Failure to excrete potassium leads to Hyperkalaemia.
Failure to excrete phosphate leads to hyperphosphatemia. Failure to activate Vitamin D impairs calcium absorption. Both lead to Hypocalcaemia.

Concept Tested & Keywords

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Practise the full Bihar CHO -2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.