Non-­‐modifiable

 risk  factors:  
-­‐Hereditary  (gene9cally   Modifiable  risk  factors:  
determined  abnormali9es  in   -­‐Diabetes  mellitus  
kidney  development  or   -­‐Hypertension  
integrity,  immune  complex   -­‐Diet  
-­‐Smoking  
deposi9on  and  inflamma9on  
in  certain  types  of   -­‐Use  of  analgesics  
glomerulonephri9s)   -­‐Toxin  inges9on  (toxin  exposure  in  
-­‐Age  greater  than  60  years  old   certain  diseases  of  the  renal  tubules  and  
-­‐Gender   inters99um  
-­‐Race  

Reduc9on  in  renal  mass  

Increased  intrarenal  ac9vity  of   Hypertension   PE:  

the  renin-­‐angiotensin  axis   BP:  
200/80mmHg  

Increased  pressure  

Decreased  GFR   Ini9al  adap9ve  hyperfiltra9on   S9mula9on  of  TGF-­‐B   Disrup9on  of  
sodium/potassium  
balance  

Impaired  elimina9on  of   Increased  glomerular   Maladap9ve  hypertrophy  

nitrogenous  wastes   permeability   and  sclerosis  
Increased  
intravascular  volume  
Reduced  excre9on  
Uremia   of  phosphate   Increased  filtra9on  of   PE:  
Inability  to  concentrate  urine  
proteins  and   Grade  II  bipedal  
Fluid  extravasa9on  
macromolecules   edema  

Further  loss  of   HPI:  

Increased   dyspnea   Edema   Dehydra9on  
synthesis  of  PTH   nephron  func9on  
PE:  bilateral  
and  parathyroid   rales  
growth  mass     Conges9ve  heart  
Loss  of  nonexcretory  renal   failuire  
func9on  

Secondary   Decreased  renal  

hyperparathyroidism   perfusion  

Diminished  calcitriol   Failure  to  produce   Impaired  insulin   Decreased  ammonia   Increased   Immune   Distrubances  in  
produc9on   erythropoe9n   ac9on   produc9on   produc9on  of  lipids   impairment   reporduc9on  

Decreased  ionized   Anemia   High  blood  glucose   Metabolic   Advanced   Delayed  wound   Infec9on   Decreased  libido  
calcium   levels/errac9c  blood   acidosis   atherosclerosis   healing   and  infer9lity  
glucose  levels  
PE:  
Pale  palpebral  
Hypocalcemia  
conjunc9vae