​Pathology - Chronic Kidney Disease

​Pathology - Chronic Kidney Disease 
Pathophysiology 
Based on eGFR, there are five stages of the disease; she is in stage 4, which denotes renal failure, with a GFR of less than 15. In 45% of cases, a complication of diabetes mellitus is the most common cause; untreated hypertension, like the one in this instance, is the second most common reason.

Nephron mass gradually decreases as a result of chronic kidney disease, regardless of the underlying reason. Renal ultrasound shows that the kidneys are tiny and fibrosed in the majority of cases. Patients can experience up to 70% nephron loss and still be asymptomatic due to hyperfiltration in the remaining nephrons. Hyperfiltration, however, damages glomeruli and hastens the loss of more nephrons.

​Fatigue and malaise are linked to anemia caused by a decrease in renal erythropoietin (EPO) output. Uremia and acidosis, which cause widespread metabolic disruption, exacerbate this. In this instance, fluid overload brought on by a loss of renal excretory capacity is contributing to the hypertension; heart failure symptoms are not yet evident. Metabolic acidosis and elevated serum phosphate and potassium are also caused by a loss of renal excretion. Reduced intestinal calcium absorption and a drop in blood calcium are caused by a loss of renal vitamin D activation. (In a different situation, the metabolism of calcium and phosphate in renal illness is covered in more detail.) Prior to renal dialysis and transplantation, patients should receive nutritional support to reduce their intake of salt, potassium, and phosphate from food, restrict their protein intake, and refill their vitamin D and EPO levels.