Unit 3 (3)

11/21/24

A consequence or result of low GFR= no kidney function which leads to hypertension or high blood pressure due to inability to filter excess blood (because of JGA function). 

Normal GFR= 90/120 mL/min x 1.73 m^2 (for adults). If GFR < 60  mL/min x 1.73 m^2 for at least three months = diagnosed as CKD

All kidney injuries → low GFR → low FILTRATION → high retention (in circulation) 

Symptoms and Signs: 

  1. Electrolytes imbalance- retention of any excess sodium, potassium, magnesium, phosphorus

    1. Adversely affects: 

    2.  the nervous system 

    3. Muscular 

    4. Cardiac 

  2. Azotemia and Uremia 

    1. Azotemia= high nitrogenous wastes (ammonia, urea, creatinine) in blood  

    2. Uremia= high urea in blood which negatively affect brain function 

Both adversely affects brain function

  1. Hypertension 

    1. Inability of kidneys to filter blood which can’t create initial filtrate so the blood volume or the liquid component of blood volume and solute wastes will increase in circulation putting pressure on the artery walls leading to high blood blood pressure 

    2. Due to JGA activity [review what the JGA does] triggers RAAS 

  2.  Edema/swollen feet and ankles due to albuminuria/hypoalbuminemia 

  3.  Anemia→ due to low numbers of RBCs in circulation because if the kidneys aren’t functioning, they aren’t making enough erythropoietin (stimulates new RBC production)

  4.  Skeletal Fractures= kidneys not making enough vitamin D→ no calcium absorption from diet leading to hormonal dysfunction so they leech it out if bones or calcium removal from bones 

Note: CKD/ESRD can occur within between 1-10 years after onset of underlying disease or trauma 

Tests and Tools: detection of CKD:

  1. Blood test

  2. Urinalysis 

Anatomical sites of renal damage/illness:

Glomeruli: 

Nephrons:

Interstitium: chronic inflammation 

Renal blood: vessels arteriosclerosis 

Causes of CKD:

  1. Chronic inflammation-based (or autoimmune) disease- eg. lupus 

  2. Infections

  3. Toxins= nephrotoxins 

    1. Medications 

      1.  NSAIDs (ibuprofen, aspirin, etc.)

      2. Antibiotics (some antibiotics)

      3.  Chemotherapy (cisplatin) 

    2. Contrast dye used in vascular imaging/angiographic procedures= chemicals (iodine) used in x-ray-based imaging techniques 

  4.  Polycystic kidney disease (PKD) = 5-10% if all ESRD cases and is considered a genetics disease 

  5. Congenital defects (structural problems during fetal development)

11/26/24

6: Hypertension: (systemic high blood pressure) 

  1. Different categories: 

i. Primary (essential) HTN→ idiopathic (unknown underlying cause)

ii. Secondary HTN→ of known cause (arteriosclerosis, diabetes, CKD) 

  1. Some researchers believe the narrow arteriolosclerosis leads to HTN  vs. others believing that HTN is what causes arteriosclerosis (i.e, fibromuscular hyperplasia) 

↓

Narrowed blood vessels decrease blood flow = high blood pressure 

            7. Diabetes Mellitus (DM)

  1. Hyaline type atherosclerosis is MORE prevalent in diabetic patients because excess sugar contributes to the high number of deposits in blood vessel lumen 

  2. 30-40% of all ESRD cases due to diabetic nephropathy (death of nephron)

i. Lack of insulin/tissue no longer responding to insulin [see figure for mechanism]

ii. Glomerulosclerosis (damage to glomerulus, hardening of glomerulus): excess sugar in circulation going to cause meningeal cells in the glomerular basement membrane to overproduce the extracellular matrix material which leads to thickening/clogging up of the glomerulus leading to low GFR = low filtration 

iii. Cross linking of proteins→ clogs up/changes glomerular basement membrane which leads to the thickening of the glomerulus (GBM) → reduced GFR = reduced filtration 

                c. High sugar in urine (glucosuria) → to bacterial infections such as urinary tract →     pyelonephritis due to UTI  (inflammation of renal tubules)

Hypertension and diabetes make up ⅔ of CKD cases 

Individuals who are at high risk: 

  • Have diabetes 

  • Have hypertension 

  • Have a family history of kidney failure 

  • Aging process / are older 

  • Specific ethnic group who are at high risk of HTN or diabetes:

  1. African americans 

  2. Latinos 

  3. Asians 

  4. Pacific Islanders 

  5. Indigenous peoples 

Treatment of CKD: 

  1. Kidney transplant 

  2. Renal or kidney dialysis 

i. Hemodialysis 

  1. dialysate/dialysis solution 

ii. Contains varying concentrations 

ii. Peritoneal dialysis