Pathophysiology Study Guide pg 41-65
Chapter 28 - Acute Kidney Injury and Chronic Kidney Disease Acute diseases can be treated
quickly whereas chronic can be more dangerous Acute Kidney Injury
● Formerly called acute kidney failure
● Known as AKI
● Sudden reduction of kidney function causing:
○ Disruptions in fluid, electrolyte, and acid-base balances
○ Acid-Base Balance also regulated by lungs so they might have shortness of breath or breathing out mo
to get rid of acid
○ They might have palpitations because they have too much electrolytes
○ Not making urine enough
○ Retention of nitrogenous waste products
■ Can cause some ammonia buildup in brain causing cognitive issues
○ Increased serum creatinine → Problem with Kidneys
■ Need to check this on a blood test
■ BUN - Blood urine nitrogen → Nitrogen is released during metabolism; tells you how well yo
liver and kidneys are functioning. That's why BUN is really important to check if its low
■ High BUN - Kidney Problems
■ Low BUN - Liver problems
■ If your liver is failing you can’t make the chemical reaction
■ Kidneys are filtration, liver is a chemical plant. If your body needs something your liver is goi
to break down molecules and make it. Nitrogenous waste products can be dangerous. You nee
to neutralize it so your liver is going to create a chemical so that you can get rid of Ammonia
from your kidneys.
○ Decreased glomerular filtration rate (GFR)
■ GFR is the measure of how well your kidneys are functioning
■ Kidneys start to get destroyed
■ Kidneys can’t filter blood
■ Gfr goes down
■ When your GFR goes down you hold onto more fluid
■ Holding onto more fluid → Increases BP
■ More strain on heart → congestive heart failure
■ Now the heart is having a hard time pumping blood to the kidneys
■ Kidneys being destroyed more
■ Can lead to anemia as your going into end stage renal failure
■ Because not getting enough RBC’s so kidneys release erythropoietin but they can’t
cause they’re not working
Prerenal kidney injury
● Happens in the Glomerulus up in the beginning of urinary system, severe dehydration
● Treated the same as Postrenal
● Prolonged prerenal ARF leads to acute tubular necrosis (intrinsic).
Acute Kidney Injury → Oliguric phase
● May last up to 8 weeks with usual urine output 50 to 400 mL/day
,Pathophysiology Study Guide pg 41-65
● Characterized by oliguria and progressive uremia; decreased GFR; hypervolemia
○ Have signs/symptoms of fluid excess, hyperkalemia, uremic syndrome
● Dialysis may be required.
● May be reversible
Postrenal kidney injury
● Because of obstruction within the urinary collecting system distal to the kidney; elevated pressure in
Bowman capsule; impedes glomerular filtration
● Prolonged postrenal ARF leads to acute tubular necrosis (intrinsic) and if continues leads to irreversible
kidney damage.
Chronic Kidney Disease
● Progressive process:
○ Chronic kidney disease (CKD)—chronic renal failure (CRF)—end-stage renal disease (ESRD)
■ ESRD: requires dialysis
● A global health problem often linked with other comorbidities, primarily hypertension and diabetes
mellitus
Chronic Kidney Disease
● Defined as decreased kidney function or kidney damage of 3 months’ duration based on blood tests,
urinalysis, and imaging studies
● Risk factors
○ Diabetes
○ Hypertension
○ Recurrent pyelonephritis
■ UTI’s
○ Glomerulonephritis
■ Kidney Infection
○ Polycystic kidney disease
○ Family history of CKD
,Pathophysiology Study Guide pg 41-65
○ Age over 65
Stages of Chronic Kidney Disease
● Focus in stage 1 and stage 2: minimizing risk factors
● By stage 3: Symptoms may be starting to appear and treatment may be needed
● In stage 4: planning for dialysis or transplant should begin
● In stage 5: renal replacement therapy needed or death will ensue
Complications of Chronic Kidney Disease
● Hypertension and cardiovascular disease
○ Hypervolemia, escalated atherosclerotic process, heightened RAAS and SNS activity
● Uremic syndrome
○ Retention of metabolic wastes; impaired healing, pruritus; dermatitis, uremic frost
● Metabolic acidosis
○ Retention of acidic waste products; hyperkalemia
● Electrolyte imbalances
○ Retained potassium, phosphorus, magnesium
● Malnutrition
○ Decreased intake from uremic
syndrome, depression, dietary
limitations, changes in taste,
protein-energy wasting;
negative nitrogen balance
● Chronic Kidney Disease has
metabolic acidosis
Chapter 29 - Disorders of the
Lower Urinary Tract
Lower Urinary Tract
● Responsible for the transport,
storage, and elimination of urine
from the body
● Structures
○ Ureters: collect urine and
transport to bladder
○ Bladder: stores and expels
urine to urethra
○ Urethra: urine exits the body
○ Associated urinary sphincters: relaxation aids voiding
Lower Urinary Tract (Cont.)
● Micturition: voiding (peeing)
● Types of disorders
○ Inflammatory
, Pathophysiology Study Guide pg 41-65
○ Obstructive
Incontinence is not normal
Chapter 28 - Acute Kidney Injury and Chronic Kidney Disease Acute diseases can be treated
quickly whereas chronic can be more dangerous Acute Kidney Injury
● Formerly called acute kidney failure
● Known as AKI
● Sudden reduction of kidney function causing:
○ Disruptions in fluid, electrolyte, and acid-base balances
○ Acid-Base Balance also regulated by lungs so they might have shortness of breath or breathing out mo
to get rid of acid
○ They might have palpitations because they have too much electrolytes
○ Not making urine enough
○ Retention of nitrogenous waste products
■ Can cause some ammonia buildup in brain causing cognitive issues
○ Increased serum creatinine → Problem with Kidneys
■ Need to check this on a blood test
■ BUN - Blood urine nitrogen → Nitrogen is released during metabolism; tells you how well yo
liver and kidneys are functioning. That's why BUN is really important to check if its low
■ High BUN - Kidney Problems
■ Low BUN - Liver problems
■ If your liver is failing you can’t make the chemical reaction
■ Kidneys are filtration, liver is a chemical plant. If your body needs something your liver is goi
to break down molecules and make it. Nitrogenous waste products can be dangerous. You nee
to neutralize it so your liver is going to create a chemical so that you can get rid of Ammonia
from your kidneys.
○ Decreased glomerular filtration rate (GFR)
■ GFR is the measure of how well your kidneys are functioning
■ Kidneys start to get destroyed
■ Kidneys can’t filter blood
■ Gfr goes down
■ When your GFR goes down you hold onto more fluid
■ Holding onto more fluid → Increases BP
■ More strain on heart → congestive heart failure
■ Now the heart is having a hard time pumping blood to the kidneys
■ Kidneys being destroyed more
■ Can lead to anemia as your going into end stage renal failure
■ Because not getting enough RBC’s so kidneys release erythropoietin but they can’t
cause they’re not working
Prerenal kidney injury
● Happens in the Glomerulus up in the beginning of urinary system, severe dehydration
● Treated the same as Postrenal
● Prolonged prerenal ARF leads to acute tubular necrosis (intrinsic).
Acute Kidney Injury → Oliguric phase
● May last up to 8 weeks with usual urine output 50 to 400 mL/day
,Pathophysiology Study Guide pg 41-65
● Characterized by oliguria and progressive uremia; decreased GFR; hypervolemia
○ Have signs/symptoms of fluid excess, hyperkalemia, uremic syndrome
● Dialysis may be required.
● May be reversible
Postrenal kidney injury
● Because of obstruction within the urinary collecting system distal to the kidney; elevated pressure in
Bowman capsule; impedes glomerular filtration
● Prolonged postrenal ARF leads to acute tubular necrosis (intrinsic) and if continues leads to irreversible
kidney damage.
Chronic Kidney Disease
● Progressive process:
○ Chronic kidney disease (CKD)—chronic renal failure (CRF)—end-stage renal disease (ESRD)
■ ESRD: requires dialysis
● A global health problem often linked with other comorbidities, primarily hypertension and diabetes
mellitus
Chronic Kidney Disease
● Defined as decreased kidney function or kidney damage of 3 months’ duration based on blood tests,
urinalysis, and imaging studies
● Risk factors
○ Diabetes
○ Hypertension
○ Recurrent pyelonephritis
■ UTI’s
○ Glomerulonephritis
■ Kidney Infection
○ Polycystic kidney disease
○ Family history of CKD
,Pathophysiology Study Guide pg 41-65
○ Age over 65
Stages of Chronic Kidney Disease
● Focus in stage 1 and stage 2: minimizing risk factors
● By stage 3: Symptoms may be starting to appear and treatment may be needed
● In stage 4: planning for dialysis or transplant should begin
● In stage 5: renal replacement therapy needed or death will ensue
Complications of Chronic Kidney Disease
● Hypertension and cardiovascular disease
○ Hypervolemia, escalated atherosclerotic process, heightened RAAS and SNS activity
● Uremic syndrome
○ Retention of metabolic wastes; impaired healing, pruritus; dermatitis, uremic frost
● Metabolic acidosis
○ Retention of acidic waste products; hyperkalemia
● Electrolyte imbalances
○ Retained potassium, phosphorus, magnesium
● Malnutrition
○ Decreased intake from uremic
syndrome, depression, dietary
limitations, changes in taste,
protein-energy wasting;
negative nitrogen balance
● Chronic Kidney Disease has
metabolic acidosis
Chapter 29 - Disorders of the
Lower Urinary Tract
Lower Urinary Tract
● Responsible for the transport,
storage, and elimination of urine
from the body
● Structures
○ Ureters: collect urine and
transport to bladder
○ Bladder: stores and expels
urine to urethra
○ Urethra: urine exits the body
○ Associated urinary sphincters: relaxation aids voiding
Lower Urinary Tract (Cont.)
● Micturition: voiding (peeing)
● Types of disorders
○ Inflammatory
, Pathophysiology Study Guide pg 41-65
○ Obstructive
Incontinence is not normal
