Concepts 3 Exam 2 Study Guide Chronic Kidney Disease Kidneys Function o Regulate fluid and electrolytes (excretes waste, nitrogenous, and metabolic) o Regulate acid-base balance (metabolic acidosis) o Regulation of blood pressure o RBC production via erythropoietin o Normal GFR is >60 ml/m o Normal BUN is 5-25 mg/dl o Normal Creatinine is 0.5–1.5 mg/dl Risk Factors o Bilateral Kidney Disease o Diabetes Mellitus o Hypertension o Older Adults o African Americans (x4) Pathology Glomerular capillary flow and pressure increase Increased demand causes glomerular sclerosis (scarring) Proteinuria from glomerular damage Nephrons are destroyed Etiology Increased fluid volume and vasular disease – Hypertension Diabetes (Increased viscosity and arterial pressure, damages glomerular capillaries) African american Elderly (decreased kidney function) Inflammation (chronic UTIs, pyelonephritis, renal calculi) Caused by o Polycystic Kidney Disease cysts compressing the renal tissue impairing renal perfusion o Diabetic Nephropathy Causing initial increase in GFR and then gradual destruction of the nephrons, decreasing the GFR o Hypertension Nephrosclerosis narrowing of renal arterioles decreasing blood flow o Chronic Glomerulonephritis
Interstitial inflammation of renal parenchyma leading to obstruction and damage of the tubules o Chronic Pyelonephritis Infection like UTI or renal calculi cause scarring and deformity of renal calyces and pelvis resulting in intrarenal reflux and nephropathy o Systemic Lupus Erythematous Immune complexes form in capillary basement membrane leading to inflammation and sclerosis Modifable causes Diabetes Obesity Hypertension Smoking High salt diets High alcoholic intake Sedentary lifestyle (no exercise) Stages o Stage One GFR >90 Kidney damage with normal or increased GFR Asymptomatic, normal BUN and creatinine o Stage Two GFR 60-89 Mildly decreased GFR Asymptomatic, possible hypertension, blood work generally within normal limits o Stage Three GFR 30-59 Moderate GFR decrease Hypertension, possible anemia and fatigue, anorexia, possible malnutrition, bone pain, slight elevation of BUN and creatinine o Stage Four GFR 15-29 Severely decreased GFR Hypertension, anemia, malnutrition, altered bone metabolism, edema, metabolic acidosis, hypercalcemia, possible uremia, azotemia with increased BUN and creatinine o Stage 5 GFR <15 End stage renal disease Kidney failure with azotemia and overt uremia Early Stage (decreased renal reserve)
o Unaffected nephrons compensate o GFR ~50% normal o Asymptomatic, normal BUN, creatinine o HTN, HA, Anorexia, Fatigue, Itching (increase in salts = uremic frost), kidney inflammation, N/V, Proteinuria, Hematuria o Infection, dehydration, nephrotoxins, obstruction can reduce function further Renal Insufficiency o Progressive nephron destruction o Urine output decreases o Increased BUN and creatinine o
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- Fall '19
- Nephrology, Chronic kidney disease, GFR