ewo Functions of the kidney and problems due to 革山院 impairment of kidney functions Kidney Functions Consequences of Dysfunction Maintain concentrations and body Hyponatremia, hyperkalemia, low total contents of electrolytes and fluid potassium content, hypocalcemia, volumes hyperphosphatemia, decreased tolerance to electrolyte or mineral loading Regulate blood pressure Hypertension, cardiovascular disease Endocrine mediators Anemia(low erythropoietin) hypertension(renin system activation) bone disease(secondary hyperparathyroidism), low vitamin D activation, prolonged half-lives of peptide hormones(e.g insulin) Waste product excretion Anorexia, nausea, soft tissue deposition of oxalates and phosphates, neurologic dysfunction, loss of muscle protein
Functions of the kidney and problems due to impairment of kidney functions Kidney Functions Consequences of Dysfunction Maintain concentrations and body contents of electrolytes and fluid volumes Hyponatremia, hyperkalemia, low total potassium content, hypocalcemia, hyperphosphatemia, decreased tolerance to electrolyte or mineral loading Regulate blood pressure Hypertension, cardiovascular disease Endocrine mediators Anemia (low erythropoietin), hypertension (renin system activation), bone disease (secondary hyperparathyroidism), low vitamin D activation, prolonged half-lives of peptide hormones (e.g., insulin) Waste product excretion Anorexia, nausea, soft tissue deposition of oxalates and phosphates, neurologic dysfunction, loss of muscle protein
Pathophysiology of CKD O Balance and steady-state Considerations The Tradeoff hypothesis ypertension Endocrine disorders Accumulation of uremic toxins
Pathophysiology of CKD • Balance and Steady-State Considerations • The Tradeoff Hypothesis • Hypertension • Endocrine Disorders • Accumulation of Uremic Toxins
Balance and steady-state 革山院 Considerations Balance state the condition in which the intake or production of a substance equals its elimination Steady state the intake or processes of production and elimination are not changing
Balance and Steady-State Considerations • Balance state – the condition in which the intake or production of a substance equals its elimination • Steady state – the intake or processes of production and elimination are not changing
革山院 The Tradeoff Hypothesis a patient with CKd will achieve balance by activating pathophysiologic responses But the responses lead to a tradeoff that has the potential of causing adverse consequences
The Tradeoff Hypothesis • A patient with CKD will achieve balance by activating pathophysiologic responses • But the responses lead to a tradeoff that has the potential of causing adverse consequences
The Tradeoff Hypothesis GFR Serum erum PTH Time a decrease in glomerular filtration rate(gfr) is followed by an increase in serum phosphorus and a decrease in serum calcium. An increase in serum arathyroid hormone(pth) returns phosphorus and calcium to normal levels
The Tradeoff Hypothesis A decrease in glomerular filtration rate (GFR) is followed by an increase in serum phosphorus and a decrease in serum calcium. An increase in serum parathyroid hormone (PTH) returns phosphorus and calcium to normal levels