Question

Explain the pathophysiology of chronic kidney disease in your own words and list typical signs, symptom and lab to assess.

What is the worst possible or most likely complication to anticipate for patients with this disease. Which body system you will most thoroughly assess due to CKD?

Answer 1

Let us first discuss the Physiology of the Kidney. The main function of the Kidney is to filter out the blood. to understand how the kidney filters the blood, we need to understand the various parts of the kidney and their functions.

Nephron is the functional unit of Kidney. The kidney contains numerous such nephrons which help in filtering the blood and production of its end product, i.e. Urine.

The various parts of the Nephron are

• Glomerular capsule/ Bowman's capsule/ Renal capsule- encloses numerous fine capillaries, filters the blood of glucose, water(some amount), amino acids(since they are large in size). This filtered blood passes through a membrane. The rate at which the filtration occurs is known as the glomerular filtration rate and important in pathophysiology of Chronic Kidney Failure.
• Proximal Convoluted tube- The toxins present in the interstitial fluid gets absorbed into the proximal convoluted tube and the resorption of water, chloride and sodium ions take place. PCT connects the Bowman's capsule to the loop of Henle
• Loop Of Henle- It can be divided into two parts, the descending loop of henle and the ascending loop of henle. Some parts of the loop are thinner and some thick (both descending and ascending). They help in the resorption of water and Na and Cl ions into the interstitial fluid while toxins get absorbed into the tube to be excreted out
• Collecting Duct- each collecting duct of the nephron collect and transport to the urine produced to a larger duct, which then gathers and flows into the urinary bladder via urethra.

Chronic Kidney Failure occurs over a period of time, just as the name suggests. The cause of the failure have been present for a long time for it to eventually lead to the failure in functioning of the organ. Chronic Kidney Failure leads to building up of toxins in the blood due to the inability to imparted functioning of the kidney to filter the blood and excrete the toxins.

The two main/most common cause of Chronic Kidney Failure are-

1. Diabetes
2. Hypertension
3. Prolonged use of drugs that affect the kidney
4. Genetic or Family history of Kidney failure

Signs and symptoms of Chronic Kidney Failure

• Unusual excretion of urine. Increase or decrease from normal level
• swelling of proximities due to water retention
• Nausea and Vomiting
• Blood in urine
• abdominal pain

Complications anticipated in patients with CKD

• Anaemia. The protein that helps in the synthesis of blood is first synthesised in the kidney. so if the kidney isn't functioning well, it directly affect in the synthesis of RBC(red blood cell)
• Bone Disorders- Kidneys help in the resorption of calcium as well. Hence, the inability to function well results in the malabsorption of calcium leading to bone disorders.
• CKD further aggravates diabetes and Hypertension
• Hyperparathyroidism- due to malabsorption of Sodium ions

Lab tests that help in assessing the functioning or lack there of, of the kidney are,

measuring the Urea and Creatinine levels present in the blood as well as urine.

The system which is first of all mostly affected by CKD is the excretory system.

The body systems which need to be assessed thoroughly due to CKD are Cardiovascular system and well as the circulatory and skeletal system.