Pathophysiology of End-Stage Renal Disease

Predisposing Factors: Precipitating Factors:

infection

Acute inflammation and damage Permeability of capillary

Pyelonephritis

Cell proliferation

Repeated Inflammation

Stage 1. GFR(>90mL/min/1.73m2)

Ischemia, nephron loss, shrinkage of kidney

Decreased renal blood flow

Decreased renal reserve Stage 2. GFR((60-89 mL/min/1.73 m2)

Damage to nephrons

50 % damage

Stage 3.
GFR (30-59 mL/min/1.73 m2)

>75% damage

Renal insufficiency

Remaining nephrons undergo changes

Remaining nephrons filter more solutes

Hypertrophy of remaining nephrons

Stage 4.
(15-29mL/min/1.73 m2)

Stage 5. END STAGE RENAL DISEASE

serum creatinine, 775

BUN, 30.9

Decreased glomerular filtration Hypertrophy of remaining nephrons

Dilute polyuria

Inability to concentrate urine Further loss of nephron function Loss of nonexcretory function

Loss of NA

hyponatremia

Dehydration

Disturbance s in reproduction
libido infertility

Immune disturbances
Delayed wound healing infection

lipid prodn

Impaired insulin action

Erratic blood glucose levels

Adv. atherosclero sis

Failure to produce erythroprote in

Anemia, pallor

Failure to convert Ca forms

Osteodystrop hy hypocalcemia

Loss of nonexcretory renal function

H2 secretion and HCO3 reabsorption

Metabolic acidosis

phosphate secretion
hypophospha tenemia

K secretion, 0.1
hyperkalem ia

Na reabsorbtion H2O retention Hypertensi on

excretion of Nitrogen wastes uric acid, 638 creatinine, 775 Uremia Proteinuria BUN, 30.9

Ca reabsorption
hypocalcem ia

Hyperparathyroidi sm

Heart failure Ascites

Azotemia

Pleural effusion

Pericarditis
CNS changes Altered taste

Peripheral nerve changes

Bleeding

Pruritus