VI.

Pathophysiology

Predisposing Factors: Precipitating Factors

Age Alcoholism
Hypertension Hypertension uncontrolled
DM DM

Alcoholism causes vasoconstriction, DM

causes the blood to become more
Increase collagen in basement
viscous.
membrane of small vessels

Increases resistance on the blood flow

Impaired/sluggish blood flow
Decrease cardiac output to peripheral
area.

Glomerulosclerosis

Release of Release of Renin

epinephrine and Decrease GFR
norepinephrine Converts
angiotensinogen to
angiotensin 1 Proteinuria

Converted to Decrease renal blood

angiotensin 2 via
ACE
Stage 1: decrease renal
reserve, GFR of 50%, more
than 7% damage
Vasoconstriction Simulation of Adrenal
cortex
Refusal to medical management
leads to persistence of condition
Release of Aldosterone

Stage 2: Renal Insufficiency

Na and H20 retention Creatinine and BUN slightly rise
Increase BP

Nephrons undergo changes for

compensation

Decrease perfusion to Kidneys

Filtration of more concentrated
blood by remaining nephron

48
 Hypertrophy of
Nephrons
Nitrogenous waste irritates pericardial sac

Intolerance or exhaustion
of the remaining Pericardial Tamponade
nephrons.

11/8/10 Chest X-Ray result:

Pericardial Tamponade
Further changes in
nephrons

80-90% damage

Refused to Medical
Management

Stage 3: renal failure,

GFR 10-20 %

11/3/10 Creatinine-7.24
mg/Dl (Increase)
Impaired kidney function 11/11/10 Creatinine-7.79
mg/dL (Increase)

Azotemia or Uremia End stage renal

failure

 Reduction of
renal capilliaries
 Scarring of Nephropathy:
Glomeruli 11/4/10 Sodium-129.80 meq/L (Decrease)
 Fibrosis of 11/5/10 Sodium-129.8 meq/L (Decrease)
Renal Tubules 11/6/10 Albumin-2.99 g/dL(Decrease)
 Kidney Damage

RAAS Malfunction

Water Nitrogenous waste

retention increase and decrease
erythropoietin
Oliguria, hpn, production 11/3/10 Hct-26.9 %, Hgb-8.7 g/Dl, RBC -3.05
edema (Decrease)
11/5/10 Hct- 23.9 %,Hgb -7.6 g/Dl(Decrease) 49
Anemia 11/11/10 RBC-3.63(Decrease), Hgb-10.6 g/Dl
Hct-32.6 g/dL
Heart failure