Intro Pathophysio

• Kidneys


  • Bean-shaped organs, each about the size of a fist
  • Process about 180 L of blood daily
  • Sifts out about 1.5-2 L of waste products and water
• Nephron


  Functional unit of the kidneys
• Glomerulus


  • Ball-shaped tuft of capillaries; plays a role in blood filtration
• Proximal Tubule


  • Various substances are actively or passively reabsorbed, secreted, or metabolized
• Distal Tubule & Loop of Henle

  • Secretion of potassium and hydrogen ions, and the regulation of water
• Medulla


  • Urine concentration
• Kidneys


  Help the body maintain chemical fluid and acid-base balances and assist in blood pressure regulation, red blood cell production, and the activation of vitamin D
• Ureter


  • Conducts urine from the kidneys to the bladder
• Bladder


  • Stores urine until it can be excreted
• Renal Artery


  • Carries blood from the heart to the kidneys
• Renal Vein


  • Carries blood from the kidneys back to the heart
• Functions of the Kidneys (AWETBED)

  • Maintaining ACID-base balance
  • Maintaining WATER balance
  • ELECTROLYTE balance
  • TOXIN removal
  • BLOOD PRESSURE control
  • making ERYTHROPOIETIN
  • vitamin D metabolism
• Calcium and phosphate are minerals that work together to help build strong bones and teeth
• Kidney disease causes an imbalance in calcium and phosphate
• Treatments for kidney disease

  • Diet
  • Phosphate binders
  • Parathyroid surgery
• The Filtering Process


  1. Blood enters the kidneys through the ARTERY from the heart

  2. Blood is cleaned by passing through millions of NEPHRONS

  3. Waste material is filtered out by nephrons and passes through the URETER and is stored in the BLADDER

  4. After the bladder becomes full, urine passes out of the body through the URETHRA

  5. Newly cleaned blood returns to the bloodstream via VEINS
• Diseases of the Kidney

  • Infection
  • Obstruction
  • Inflammation
  • Hypertension
  • Diabetes
  • Drugs, herbal medicine, solvents, and insecticides
  • Abnormalities in the urinary tract
• Signs and Symptoms Related to the kidneys ability to perform its function

  • Edema
  • Hyperkalemia
  • Metabolic acidosis (H ions)
  • Anemia
  • Azotemia
  • Oliguria
  • Hypertension
  • Renal osteodystrophy
  • Secondary parathyroidism
• Edema Depth


  • 1+ (2 mm or less indentation, disappear rapidly) = Mild pitting edema
  • 2+ (2-4 mm indentation, 15 seconds to rebound) = Moderate pitting edema
  • 3+ (4-6 mm indentation, 30 seconds to rebound) = Moderately severe pitting edema
  • 4+ (6-8 mm indentation, >60 seconds to rebound) = Severe pitting edema
• ●       Majority of renal patients have edema or anasarca (edema from head to feet).

  ●       Sodium, potassium, calcium and phosphorus (electrolyte)

  ●       If kidney is not functioning, there is too much toxin in the body

  Erythropoietin - responsible for blood production
• ●       If phosphorus increases, calcium decreases

  ●       If calcium is high, it needs calcitonin which inhibits vitamin D

  ●       If calcium is low, calcitonin is stopped; Parathyroid Hormone (PTH) is released

  ●       In renal, calcium is low

  ●       PTH - activates vitamin D

  If calcitonin is high, it inhibits calcium
• 3 Steps of Filtration

  ●       Glomerular Filtration

  ○       Glomerolus act as sieve to filter the blood

  ●       Tubular Reabsorption

  ○       Wanted substances will be reabsorbed (like H, potassium)

  ●       Tubular Secretion

  Unwanted waste will go to ureter and stored in the bladder, secreted out in through the urethra
• ●       Metabolic acidosis

  ○       Imbalance of Hydrogen and bicarbonate

  ○       May also be due to too much K

  ●       Oliguria
• ●       Oliguria

  ○       Polyuria is the frequent urination

  ○       Oliguria is less urination

  ○       Anuria is no urination

  ○       That is why there is fluid retention; if there is impaired function, then the urine will not be released.

  ○       Diuretics is given to get rid of water and increase urination to decrease risk for azotemia
• ●       Renal osteodystrophy

  Most renal patients, especially CKD stages 3-5, have weaker bones
• ●       There is edema due to water retention

  ○       You can check albumin, one of the markers that we check for malnutrition

  ○       If albumin is very low or is secreted in the urine, it could be edema

  ○       Fluid shifts to the interstitial spaces

  ○       Edema may also be because of Hypertension, too much sodium
• ●       How to get rid of edema?

  ○       Doctor may prescribe diuretics to remove excess fluid

  ○       Fluid restriction; in renal patients it is important to take note of output

  Reduce the sodium intake.