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

BUN

Dilute Polyuri a
Dehydration

Loss of Sodium in Urine

Hyponatremi a

Loss of nonexcretory renal function

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

Anemi a Pallor

Erratic blood glucose levels

Delayed wound healing

Infectio n

Libid o

Infertility

1 Hypocalcemi a Excretion of nitrogenous waste Uremia Osteodystroph y Decreased sodium reabsorption in tubule Water Retention

Loss of excretory renal function Decreased potassium excretion Decreased phosphate excretion Decreased hydrogen excretion

Hyperkalemia

Hyperphosphatemi a Decreased calcium absorption

Metabolic acidosis

BUN, Creatinine Uric Acid

Hypertension Heart Failure Edema

Proteniuria

Hypocalcemi a Hyperparathyroidism Decreased potassium excretion

Peripheral nerve changes

Pericarditi s

Increased potassium

CNS changes

Pruritu s Altered Taste Bleeding Tendencie s