Pathophysiology - ESRD

Pathophysiology Predisposing Factor (Non Modifiable) Hypertension, Diabetes

Contributing Factor (Modifiable) UTI, Smoking, Alcohol, Glomerulonephritis Damage to the nephrons Progressive lost of functional nephrons

Diminished renal reserve (30 ~ 50% loss of kidney function)

Hyposthenuria

Polyuria

Renal Insufficiency (51 ~ 75% loss of kidney

Oliguria Isosthenuria

ESRD (90% loss of kidney function) Anuria

Excessive amounts of metabolic waste are

Kidneys are unable to

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Metabolic Changes

Excessive accumulation of sodium

Hypertension Hypernatremia

Edema (peripheral or pulmonary)

Excessive Hyperkalemia

Dysrhythmia

↓ Production of Vit D ↓ Ca Absorption On GI tract

Hypocalcemia Release of PTH

Phosphate retention

Bone resorption

Hyperphosphatemia Renal Osteodysthrophy

Acid Base Imbalance

Metastatic Calcifications ↓ Acid excretion (Hydrogen ions) Metabolic Acidosis ↑ Rate and depth of breathing

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Cardiac Changes

Malfunction in RAAS Sodium & H2o retention

↑ BP

Edema (pulmonary of peripheral)

Hypertension

↑ Workload of the heart Left Ventricular hypertrophy Heart Failure

Hematologic Changes

↓ Erythopoietin ↓ RBC Production

Anemia

Fatigue

Uremia

Accumulation of toxins in the blood

Impaired platelet

Uremic toxins reach the heart

Inflammation of pericardial sac

Impairs Immune system Risk for Infection

Bleeding tendencies Chest pain

Fever Cardiac Tamponade

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GI disturbances

Normal Flora

Production of Urease

Uremic Halitosis

Nausea & Vomiting

Breaks down

Anorexia

Uremic toxins ↑ Ammonia

Stomatitis

Lethargy

Irritability

Peptic Ulcer Uremic Colitis Bleeding

Seizure Hemorrhagic shock

Coma

Uremic Encephalopathy Uremic toxins reach the skin

Urochrome Jaundice

Pruritus

Uremic Frost

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Reproductive Disturbances

↓ Level of estrogen,

Anovulation

Fatigue ↓ Testosterone Level

Decrease libido

Low Sperm Count

Impotence

Amennorrhea