Question

Stage 5 CKD: Describe the pathophysiology; GFR lab values, manifestations, electrolyte problems, (be sure to include a discussion on water imbalances, electrolytes (sodium, potassium, bicarbonate, calcium, phosphate), nitrogen compounds and Vitamin D. What is done to manage CKD at this stage?

Answer 1

PATHOPHYSIOLOGY OF CHRONIC KIDNEY DISEASE

When discussing the pathophysiology of CKD, renal structural and physiological characteristics, as well as the principles of renal tissue injury and repair should be taken into consideration.

Firstly, the rate of renal blood flow of approximately 400 ml/100g of tissue per minute is much greater than that observed in other well perfused vascular beds such as heart, liver and brain. As a consequence, renal tissue might be exposed to a significant quantity of any potentially harmful circulating agents or substances. Secondly, glomerular filtration is dependent on rather high intra- and transglomerular pressure (even under physiologic conditions), rendering the glomerular capillaries vulnerable to hemodynamic injury, in contrast to other capillary beds. In line with this, Brenner and coworkers identified glomerular hypertension and hyperfiltration as major contributors to the progression of chronic renal disease. Thirdly, glomerular filtration membrane has negatively charged molecules which serve as a barrier retarding anionic macromolecules. With disruption in this electrostatic barrier, as is the case in many forms of glomerular injury, plasma protein gains access to the glomerular filtrate. Fourthly, the sequential organization of nephron’s microvasculature (glomerular convolute and the peritubular capillary network) and the downstream position of the tubuli with respect to glomeruli, not only maintains the glomerulo-tubular balance but also facilitates the spreading of glomerular injury to tubulointerstitial compartment in disease, exposing tubular epithelial cells to abnormal ultrafiltrate. As peritubular vasculature underlies glomerular circulation, some mediators of glomerular inflammatory reaction may overflow into the peritubular circulation contributing to the interstitial inflammatory reaction frequently recorded in glomerular disease. Moreover, any decrease in preglomerular or glomerular perfusion leads to decrease in peritubular blood flow, which, depending on the degree of hypoxia, entails tubulointerstitial injury and tissue remodeling. Thus, the concept of the nephron as a functional unit applies not only to renal physiology, but also to the pathophysiology of renal diseases. In the fifth place, the glomerulus itself should also be regarded as a functional unit with each of its individual constituents, i.e. endothothelial, mesangial, visceral and parietal epithelial cells - podocytes, and their extracellular matrix representing an integral part of the normal function. Damage to one will in part affect the other through different mechanisms, direct cell-cell connections (e.g., gap junctions), soluble mediators such as chemokines, cytokines, growth factors, and changes in matrix and basement membrane composition.

The main causes of renal injury are based on immunologic reactions (initiated by immune complexes or immune cells), tissue hypoxia and ischaemia, exogenic agents like drugs, endogenous substances like glucose or paraproteins and others, and genetic defects. Irrespective of the underlying cause glomerulosclerosis and tubulointerstitial fibrosis are common to CKD.

In stage 5 chronic kidney disease GFR value will be less than 15. That means the kidneys are getting very close to failure or have completely failed.

The manifestation include

* Itching

* Muscle cramps

* Feeling sick and throwing up

* Not feeling hungry

* Swelling in hands and feet

* Back pain

* Urinating more or less than normal

* Trouble breathing

*Trouble sleeping

In renal failure, one most commonly sees patients who have a tendency to develop hypervolemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and bicarbonate deficiency. Sodium is generally retained but may appear normal, or hyponatremic, because of dilution from fluid retention.

Management

Dialysis - Dialysis helps to clean the blood when kidneys are failed.

Kidney Transplant - It is a surgery to give you a healthy kidney from someone else body.