PATHOPHYSIOLOGY

(Chronic Renal Failure)

Predisposing
Factors:

Precipitating
Factors:

Ages 55 and
above

Lifestyle
- smoking
- alcohol drinking

Family History
(Diabetes Mellitus,
Hypertension)

Certain Diseases
(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
-Scarring of Glomeruli
- Atrophy & Fibrosis of
Renal tubules

Nitrogenous
wastes impairs
platelets

Malfunction of
RAAS

> 90 % of
kidney
damage

Decreased
Erythropoietin
Production
Continuous
decline in renal
function

Bleeding
tendencies

Na & H2O
retention

ANEMIA

Toxins irritate
pericardial sac
Pericarditis
Cardiac
Tamponade

-fatigue
- weakness

Toxins impair
immune
system
Decreased
Immune
system

Increased
blood
pressure

Edema

Pulmonary
Edema,
Peripheral
Edema

Uremic
frost

Risk for
superinfection

Decreased
Urine
Output

Urea
deposits
on the skin

Stage IV
END-STAGE RENAL
DISEASE
(ESRD)
GFR <10%

Sepsis

Toxins
affect
CNS

Oliguria
Hypertension

Continuous Multisystem
Affectation
Multiple Organ Failure

Heart Failure

DEATH

Uremic
Encephalopathy
-changes in
mentation/
psychiatric
symptoms
-irritability
-fatigue
-insomnia