Chronic Renal Failure Pathophysiology (7.7)

Question 1

Understand the physiological adaptations that allow the kidneys to maintain homeostasis despite falling GFR in the context of CKD

Characteristics features, changes in individual ion levels, treatment

Answer 1

Characteristic features: Hypertension, proteinuria, glomerularsclerosis and progressive loss of renal function

Question 2

Understand endocrine consequences of CKD

Treatment, main cause of CKD symptoms?

Answer 2

Question 3

Understand mechnanisms of CKD progression and the rationale for interventions to slow this

Answer 3

Interventions:

• Control hypertension: CVD is the biggest cause of death amongst CKD patients. Controlling blood pressure will decreased end organ failure. Also, provision of lifestyle and dietary advice to decrease other cardiovascular complications
• Correct electrolyte disturbances:

Supplement calcium

Use of phosphate binders (decreasing PO_4^-) and HCO₃^- (to correct acidosis)

• Correct disturbances in endocrine function:

Supplement Vitamin D

Use of EPO stimulating agents or iron supplementation

Question 4

Describe the KDOQI and KDIGO classification systems for CKD

Answer 4

Question 5

State the key features of chronic renal failure

Answer 5

↓ Excretory function

↓ Capacity to concentrate urine

↓ Synthetic and endocrine function

Progressive renal damage