Chronic Kidney Disease

A. PATHOPHYSIOLOGY
a. Schematic Diagram

Non-Modifiable Factors
-Hereditary
-Age greater than 60 years
old
-Gender
-Race

Modifiable Factors
-Diabetic Mellitus
-Hypertension
-Increase Protein and
Cholesterol Intake
-Smoking
-Use of analgesics

Decreased renal blood flow

Primary kidney disease
Damage from other diseases
Urine outflow obstruction
BUN

Dilute
Polyuria

Dehydration

Decreased
glomerular filtration
Hypertrophy of
remaining nephrons

Serum
Creatinine

Loss of Sodium
in Urine

Hyponatremia

Inability to
concentrate urine
Further loss of
nephron function

Loss of nonexcretory
renal function

Failure to convert
inactive forms of
calcium
Calcium
absorption

Failure to produce
eryhtropoietin
Anemia
Pallor

2
a

Impaired insulin
action
Erratic blood
glucose levels

Production of
lipids
Advanced
atherosclerosis

Immune
disturbances

Delayed wound
healing

Disturbances in
reproduction

Infection

Libido

Infertility

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1
Hypocalcemia

Excretion of
nitrogenous
waste
Uremia
BUN,
Creatinine
Uric Acid

Proteniuria

Peripheral nerve
changes

Osteodystrophy

Decreased
sodium
reabsorption in
tubule
Water Retention
Hypertension
Heart Failure
Edema

2
a

Loss of excretory
renal function
Decreased
potassium
excretion
Hyperkalemia

Decreased
phosphate
excretion

Decreased
hydrogen
excretion

Hyperphosphatemia

Metabolic acidosis

Decreased
calcium
absorption
Hypocalcemia
Hyperparathyroidism
Decreased
potassium excretion

Pericarditis

CNS changes

Pruritus
Altered Taste
Bleeding
Tendencies

Increased potassium