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 Decreased glomerular filtration Hypertrophy of remaining nephrons Inability to concentrate urine Dehydration Further loss of nephron function Serum Creatinine

Dilute Polyuria

Loss of Sodium in Urine

Hyponatremia

Loss of nonexcretory renal function

2

Failure to convert inactive forms of calcium Calcium absorption

Failure to produce eryhtropoietin

Impaired insulin action

Production of lipids Advanced atherosclerosis

Immune disturbances

Disturbances in reproduction

Anemia Pallor

Erratic blood glucose levels

Delayed wound healing

Infection

Libido

Infertility

1

1 Hypocalcemia Osteodystrophy 2 Loss of excretory renal function Decreased potassium excretion Decreased phosphate excretion Decreased hydrogen excretion Excretion of nitrogenous waste Uremia BUN. Creatinine Uric Acid Decreased sodium reabsorption in tubule Water Retention Hypertension Heart Failure Edema Hyperkalemia Hyperphosphatemia Metabolic acidosis Decreased calcium absorption Hypocalcemia Hyperparathyroidism Decreased potassium excretion Proteniuria Peripheral nerve changes Pericarditis Increased potassium CNS changes Pruritus Altered Taste Bleeding Tendencies .