PATHOPHYSIOLOGY OF CHRONIC RENAL FAILURE SECONDARY TO CHRONIC GLOMERULONEPHRITIS

LEGEND
Flow of the disease process Signs and Symptoms Predisposing Factors Age 55 and above Family History (DM, Hypertension)

Race(African-American,NativeAmerican or Asian-American)

Precipitating Factors Lifestyle - Diet - Smoking - Alcohol drinking Certain Diseases (Hypertension, DM, Recurrent Infections, Autoimmune disorder)

Thickening and / or an in the amount of collagen in the basement membranes of the small vessels Impaired / sluggish blood flow Glomerulosclerosis

Continuous irritation from large molecules Triggers inflammatory response

Proteinuri a Hematuria

Glumerulonephritis
Further narrowing of Glumeruli Stage I Diminished Renal Reserve GFR 40-70 ml/min More than 75% Damage Stage II Renal Insufficiency GFR 20-40 ml/min

Normal BUN, Creatinine

BUN, Creatinine Levels begin to rise

Remaining Nephrons undergo changes to compensate for those damaged nephrons Filtration of more concentrated blood by the remaining nephrons Hypertrophy of Nephrons Intolerance and Exhaustion of the remaining nephrons Further Damage of the Nephrons 80-90% Damage Stage III Renal Failure GFR 10-20% Impaired Kidney Functions and uremia - Reduction in renal capillaries - Scarring of Glomeruli - Atrophy and Fibrosis of Renal Tubule

90% of Kidney Damage

CHRONIC RENAL FAILURE

With medical and nursing management: medical and nursing management:

Diagnostic tests: Glomerular Filtration Rate Sodium and Water Retention Acidosis Anemia Calcium and Phosphorus imbalance Medical Management: Pharmacologic Therapy Calcium and phosphorus binders Antihypertensive and Cardiovascular Agents Anti-seizure agents Erythropoietin Nursing Management:

Without

- Careful regulation of protein intake

- Fluid intake to balance fluid losses (500-600ml)

- Some restriction of potassium

- Adequate caloric intake and vitamin supplement

-Identify and treat specific causes of chronic kidney disease

- Assess for cardiovascular risk factors, which might cause rapid decline in eGFR -Vigilant monitoring of blood pressure - Monitor weight and instigate weight management plans -Monitor cholesterol levels -Avoid nephrotoxic drugs, for example, non-steroidal anti-inflammatory drugs -Provide information to enable patients to make informed choice about renal replacement therapy and conservative management -Dietary advice to prevent malnutrition -Psychological support

Urea Toxins affect Malfunction Nitrogenous Waste Erythropoietin Continuous Toxins Toxins deposits of RAAS Impairs Platelets Production Irritate Decline Impaired CNS Pericardial Immune on the In Renal skin Bleeding Sac Function System Uremic Na & H20 -Fatigue Tenderness Encephalopath Retention Pericarditis Immune Stage IV y Weaknes End Stage Renal System -Low s Disease (ESRD) Cardiac changes platele -oliguria GFR < 10% Tamponade Risk for Super itchi in ness t -hypertension infection mentati -pulmonary Continuous count on / edema Multisystem Sepsis psychiat -Peripheral Affectation ric edema sympto Multiple Organ ms Failure Irritability Fatigue Death -Insomnia