PATHOPHYSIOLOGY

(Chronic Renal Failure)

Predisposing Precipitating
Factors: Factors:

■ Ages 55 and ■ Lifestyle

above - smoking
- alcohol drinking
■ Family History
(Diabetes Mellitus, ■ Certain Diseases
Hypertension) (Hypertension,
Diabetes Mellitus,
Recurrent
infections

Thickening and/or an
in the amount of collagen in
the basement membranes
of the small vessels

Impaired/sluggish blood flow

Glomerulosclerosis

GFR
(Glomerular Filtration Rate)

proteinuria

Renal blood

Stage I
DIMINISHED RENAL
RESERVE
GFR 50%
 Normal BUN,
creatinine

More than 75%

damage

Stage II
RENAL INSUFFICIENCY
GFR 20-50%

BUN, creatinine
levels begin to rise

Remaining nephrons undergo

changes to compensate for
those damaged nephrons

Filtration of more concentrated

blood by the remaining
nephrons

Hypertrophy of
nephrons

Intolerance and
exhaustion of the
remaining nephrons

Further damage of
the nephrons

80-90% damage

Stage III
RENAL FAILURE
GFR 10-20%

Impaired kidney
function and
Uremia
 - Reduction in renal
capillaries > 90 % of
-Scarring of Glomeruli kidney
- Atrophy & Fibrosis of damage
Renal tubules

Nitrogenous Decreased Toxins irritate Toxins impair Urea

Malfunction of wastes impairs Erythropoietin pericardial sac immune deposits
RAAS platelets Production system on the skin
Continuous Pericarditis
Bleeding decline in renal Decreased
Na & H2O tendencies function Immune
system Uremic
retention Cardiac frost
Tamponade
ANEMIA -fatigue
- weakness Risk for
superinfection
Toxins
┼ affect
Pulmonary Stage IV Sepsis CNS
Decreased Increased
Edema Edema, END-STAGE RENAL
Urine blood
Peripheral DISEASE
Output pressure
Edema (ESRD)
GFR <10%
Oliguria
Hypertension
Continuous Multisystem
Uremic
Affectation
┼ Encephalopathy

Multiple Organ Failure

Heart Failure -changes in
mentation/
psychiatric
DEATH symptoms
┼
-irritability
┼ -fatigue
-insomnia