End Stage Renal

Disease (ESRD)
Prepared by:
Abellana, Mary Catherine T.
Acapulco, Kyla Faye C.
Acaso, Ashley Sue P.
Acedillo Carmela Marie C.
Apa, Karen L.
Arias, Romero Y.
Balili, Jirah Grace C.
Banuag, Mary Jo A.
Bazar, Brixie Lyka C.
Anatomy and Physiology
Urinary System
 OVERVIEW

•Maintains the purity and constancy of

our internal fluid
•Filters gallons of fluid from the
bloodstream.
•Regulate
–Blood volume and chemical makeup to maintain the
proper balance between H2O and Salt and between acids and
bases.
–Blood pressure Renin
•Erythropoietin
•Vit. D to its active form
Location and
Structure
NEPHRONS

● Basic functional unit

● Million tiny structures
● Consist of 2 main structure
○ Renal corpuscle
○ Renal tubule
Renal Corpuscle

Consist of:
● Glomerulus
● Bowman’s capsule
○ Podocytes
○ Filtration slits
Renal tubule
● About 3 cm long
● Different regions of the tubule have specific names
■ Proximal convoluted tubule (PCT)
■ Loop of Henle
■ Distal convoluted tubule (DCT)
● Cortical nephrons
○ Located within the cortex
● Juxtamedullary nephron
○ Situated close to the cortex-
medulla junction and the
nephron loops dip deep into the
medulla.
● Collecting ducts
○ Deliver urine to the renal pyramid then
to the calyces and renal pelvis.
Each and every nephron is associated with two
capillary bed

1. Glomerulus

-afferent and efferent arterioles

2. Peritubular capillary bed

-low pressure

- porous vessels

-cling closely to the whole renal tubule

Disease definition
End-stage renal disease, also called end-stage kidney disease or kidney failure,
occurs when chronic kidney disease — the gradual loss of kidney function — reaches
an advanced state. In end-stage renal disease, your kidneys no longer work as they
should to meet your body's needs.

Your kidneys filter wastes and excess fluids from your blood, which are then excreted
in your urine. When your kidneys lose their filtering abilities, dangerous levels of fluid,
electrolytes and wastes can build up in your body

With end-stage renal disease, you need dialysis or a kidney transplant to stay alive.
But you can also choose to opt for conservative care to manage your symptoms —
aiming for the best quality of life during your remaining time.
Risk Factors
Certain factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease,
including:

● Diabetes with poor blood sugar control

● Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood
● Polycystic kidney disease
● High blood pressure
● Tobacco use
● Black, Hispanic, Asian, Pacific Islander or American Indian heritage
● Family history of kidney failure
● Older age
● Frequent use of medications that could be damaging to the kidney
Pathophysiology

END-STAGE RENAL DISEASE

 DIABETES Hypertension

Increased RBF Glomerular

hyperfiltration
Sodium Retention

Increased tubular
reabsorption
 Increased O2
consumption

-Decreased nitric
oxide, increased Tissue -Tubulointerstitial injury
RAS hypoxia -Microvascular
-Insufficient HIF rarefaction
activation -Glomerlulosclerosis
-Decreased AMPK

CKD

s/sx start to
appear during this
stage
Drug study
indicated for chronic
renal insufficiency
with the following
conditions: Given
with high calorie, low
protein food <40 g
daily; Compensated
or decompensated
retention; Glomerular
filtration rate (GFR) of
5-50 mL/minute.
The primary mechanism
of action of febuxostat
evaluated in trials was
the inhibition of xanthine
oxidase, evidenced by
the increase in serum and
urine xanthine
concentrations, decrease
in serum and urine uric
acid levels, and lack of
significant reduction in
total purine synthesis.
Problem list

1. Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water.

2. Impaired Urinary Elimination related to failing glomerular filtration AEB Impaired excretion of nitrogenous
products secondary to Renal Failure

3. Acute pain related to the trauma that the kidney experience perceive by the body as a threat

Risk for systemic infection related to hemodialysis procedure as manifested by fatigue, weakness and low
hemoglobin and hematocrit Level

4. Imbalanced nutrition less than body requirements related to anorexia, nausea, vomiting, dietary restrictions,
and altered oral mucous membranes.

5. Risk for systemic infection related to hemodialysis procedure as manifested by fatigue, weakness and low
hemoglobin and hematocrit Level
NCP