​Pathology - Chronic Kidney Disease

​Pathology - Chronic Kidney Disease
Linked to diabetes, hypertension, glomerular illnesses such as RPGN, vasculitides like Wegener granulomatosis, renal artery stenosis, medicines such as lithium and sulfa drugs, infections, or autoimmune diseases like SLE.
 

As glomerular filtration rate decreases, the kidney's ability to regulate electrolyte balances, such as potassium excretion leading to hyperkalemia, and sodium and water handling causing volume overload, diminishes. Additionally, the kidney's capacity to maintain pH balance is compromised, resulting in metabolic acidosis due to insufficient ammonia production to bind with endogenous acid and be excreted as ammonium. Anemia occurs due to reduced production of erythropoietin by malfunctioning kidneys.

Clinical Symptoms 
Initially asymptomatic, chronic kidney disease (CKD) advances to cause symptoms such as edema, dyspnea due to volume overload, fatigue, and weakness.
Possible complications consist of cardiac arrhythmias due to electrolyte imbalances, encephalopathy, platelet dysfunction, renal osteodystrophy, and pericarditis.

Laboratory results indicate anemia, increased blood urea nitrogen (BUN) and creatinine levels, metabolic acidosis, low calcium levels (hypocalcemia), high phosphate levels (hyperphosphatemia), and high potassium levels (hyperkalemia).

Prescribe ACE inhibitors and diuretics, check electrolytes, administer phosphate binders, manage underlying disease. Advanced stages may necessitate dialysis or transplant.
Individuals undergoing long-term dialysis for chronic kidney disease have a 5-year survival rate of 35%.
Reasons to start dialysis in chronic kidney disease include metabolic imbalances such as acidosis and hyperkalemia, controlling excess fluid, advancing uremic encephalopathy, and managing symptoms of uremia such malnutrition, pericarditis, or pleuritis.