1st lec

Pathophysiology notes
▪ The urinary system composed of: Etiology
-The kidneys • Diseases and conditions that commonly cause chronic kidney
-The ureters. disease include:
-The urinary bladder. - Diabetes mellitus (44%).
-The urethra. - High blood pressure (28%).
Nephron - Chronic glomerulonephritis (7%).
• Is the basic structural and functional unit of the - Interstitial nephritis.
kidney. • Polycystic kidney disease
• In humans, a normal kidney contains 800,000 to 1.5 • Prolonged obstruction of the urinary tract, from conditions
million nephrons. such as enlarged prostate, kidney stones and some cancers
• Each nephrons has two major components: • Renal artery stenosis
1. A glomerulus • Renal carcinoma
2. A long tube • Human immunodeficiency virus– associated nephropathy
• Structure of nephron Pathophysiology of CKD
– glomerulus Progressive destruction of nephrons leads to:
– proximal convoluted tubule. a. Decreased glomerular filtration, tubular reabsorption &
– loop of Henle renal hormone regulation.
descending limb b. Remaining functional nephrons compensate
ascending limb c. Functional and structural changes occur.
– distal convoluted tubule d. Inflammatory response triggered.
– collecting duct e. Healthy glomeruli so overburdened they become stiff,
Functions of kidney sclerotic and necrotic.
1. Excretion of waste product. Functional Changes of CRF:
2. Regulation of fluid, electrolyte and acid-base The Kidneys are unable to:
balance. • Regulate fluids and electrolytes.
3. Production of erythropoietin, renin, prostaglandins. • Balance fluid volume and renin-angiotensin system.
4. Metabolism of vitamin D. • Control blood pressure.
Chronic Kidney Disease • Eliminate nitrogen and other wastes.
• characterized by a progressive deterioration in kidney • Synthesize erythropoietin.
function with time characterized by irreversible structural • Regulate serum phosphate and calcium levels.
damage to existing nephrons Drug-Induced Causes of Chronic Kidney Disease
• Unlike acute renal failure, which happens suddenly, Analgesic nephropathy:
chronic renal failure happens gradually over a period of time - Results from habitual ingestion of analgesics for many years.
leading to end stage renal disease (ESRD) - Agents containing at least two antipyretic analgesics are
• The progression is so slow that symptoms usually don't commonly associated with the development of CKD.
appear until major damage is done. - It is a tubulointerstitial kidney disease.
• The presence of protein in the urine is an early and sensitive - Analgesic nephropathy is a slowly progressive disease,
marker of kidney damage. and the clinical signs and symptoms are similar to the
Chronic Kidney Disease nonspecific presentation of CKD
Definitions Lithium nephropathy: (lithium is used for psychotic pts)
1.Azotemia: the accumulation of nitrogenous wastes such as - Lithium use has been associated with alterations in kidney
urea in the plasma. function secondary to acute functional and histological
2.Uremia - azotemia with symptoms or signs of renal failure. changes.
3.End Stage Renal Disease (ESRD): uremia requiring - Lithium-induced chronic renal disease has a slow progression
transplantation or dialysis. (20 years).
4.Creatinine Clearance (CCr) the rate of filtration of creatinine - Patients with lithium nephropathy are generally
by the kidney (GFR marker). asymptomatic, with an insidious decline in renal function over
5.Glomerular Filtration Rate (GFR) - the total rate of filtration the course of many years.
of blood by the kidney. - patient needs close monitoring of serum lithium & SCr.
Clinical Features
• Signs and symptoms of kidney disease are often nonspecific,
meaning they can also be caused by other illnesses.
• Signs and symptoms may not appear until irreversible
damage has occurred.
• Renal disease is first detected by the discovery of
proteinuria, hypertension, or azotemia on routine medical
examination.
• Symptoms are generally absent in CKD stages 1 and 2, and
may be minimal during stages 3 and 4.
• General symptoms associated with stages 1 to 4 include
edema, cold intolerance, shortness of breath, palpitations,
cramping and muscle pain, depression, anxiety, fatigue, and
sexual dysfunction.
• Cardiovascular–pulmonary: Edema and worsening
hypertension, electrocardiographic evidence of left ventricular
hypertrophy, hyperhomocysteinemia, arrhythmias, and
dyslipidemia.
• Gastrointestinal: Gastroesophageal reflux disease, weight
loss.
• Endocrine: Secondary hyperparathyroidism, decreased
vitamin D activation, β2-microglobulin deposition, and gout.
• Hematologic: Anemia of CKD, iron deficiency, and bleeding.
• Fluid/electrolytes: Hyper- or hyponatremia, hyperkalemia,
and metabolic acidosis.
Laboratory Investigation
• Blood urea nitrogen (BUN) = Increased.
• Serum creatinine = Increased.
• Serum electrolytes; Potassium = increased.
Phosphorous = increased.
Calcium = decreased.
• Proteinuria, microalbuminuria
• Complete blood count (CBC) = anemia
• Estimated GFR (eGFR): calculate an estimated GFR; helpful in
the stage of chronic kidney disease
Other Diagnostic tests
• Other tests that may be done to look for the cause or type of
kidney disease include:
- Ultrasound of the abdomen
- Kidney biopsy
- CT scan of the abdomen
- MRI of the abdomen
Complications
1. Fluid and electrolyte abnormalities.
2. Cardiovascular complications
3. Mineral and bone disorder
4. Anemia.
5. Metabolic acidosis.
6. Poor nutritional status.
H H
H H