Pathophysiology Final Deborah Dollmeyer HCR 240 Scottsdale Community College SCC

When the renal function is impaired to 25% or GFR is 25-30 ml/min

Prerenal, intrarenal, and postrenal

• Hypovolemia
• Hemorrhage
• Hypotension
• Hypoperfusion

• Cortical necrosis
• Acute glomerulonephritis
• Vascular disease
• Allograft disease
• Interstitial disease

MetabolicMetabolic acidosis, hyperkalemia, hyponatremia, hypocalcemia, hyperphosphatemia, hypermagnesemia, hyperuricemiaCardiovascularPulmonary edema, arrhythmias, pericarditis, pericardial effusion, pulmonary embolism, hypertension, myocardial infarctionGastrointestinalNausea, vomiting, malnutritionNeurologicNeuromuscular irritability, asterixis, seizuresHematologicAnemia, bleeding, gastrointestinal hemorrhageInfectiousPneumonia, septicemia, urinary tract infectionOtherHiccups, elevated parathyroid hormone, normal to low total triiodothyronine and thyroxine, mental status changes

• Correcting fluid and electrolyte disturbances
• Treating infections
• Maintaining nutrition
• Altering medication dosing or discontinuing drugs as necessary because of the lack of excretion and resulting possible toxicity

Because the loss of renal function is irreversible

• GFR is about 50% of normal
• Blood urea nitrogen (BUN) level may be elevated

• Severely reduced GFR
• Mild azotemia
• Nocturia
• Mild anemia
• Impaired renal function during stress

• Azotemia
• Acidosis
• Impaired urine dilution
• Severe anemia
• Electrolyte disturbances
• GFR less than 20% of normal

• GFR nearly absent
• Severe electrolyte disturbance
• Severe acidosis
• Impairments in nonrenal organ systems

• Increased BUN
• Increased creatinine
• Decreased GFR

• Dietary control, including:
• Protein restriction
• Potassium restriction
• Nutritional interventions to assure adequate caloric intake
• Electrolyte stabilization
• Dialysis
  The decision to initiate dialysis is frequently based on the patient's signs and symptoms and not just a single lab value. However, the issue of hyperkalemia and its potential cardiac complications often is the most pressing factor in the decision to dialyze. The decision may also be based on the staging of kidney disease and the determination of glomerular filtration rate. Typically, when the GFR falls below 15, dialysis is indicated.

• Urethral sphincter
• Inherited antigens
• Mucus-secreting glands in the urethra
• Urine itself

• Sexually active women, especially those using a diaphragm or spermicide
• Patients with:
• An indwelling catheter or other instrumentation of the urinary system
• Lower urinary tract obstruction
• Diabetes mellitus
• Immunosuppression