Increase susceptibility

Number of functional nephrons Nicotine Buildup of fats Dietary purine Purine Synthesis
Chronic hyperglycemia

Intracellular concentration Clearance of toxins Hardening of arteries Impaired uric secretion
Formation of glycoprotein Constrict blood vessels Hyperuricemia
Glomerulosclerosis Uric Acid Crystals disposition
Diabetic nephropathy Renal tissue damage & inflammation
Damage to glomeruli Damage to renal arteries Constrict blood vessels


Renal hypoperfusion Activation of RAAM
Nephron damage Aldosterone & Angiotensin II
GFR Activates SNS vasoconstriction
Renal function Blood Pressure/Volume Water leaves the blood vessels
DIABETES
MELLITUS (for
8 years)
AGE 61 y/o

MALE
SMOKING
(for 33 years)
ALCOHOLISM
CHRONIC MEAT
EATING (beef, lamb for
14 yrs.)
HYPERTENSION
NEPHROSCLEROSIS ARTERIOSCLEROSIS
Family Hx of
DM (Mother)
Nifedipine, Amlodipine
Proteinuria (+2)
Sitigliptin
Stage 1: Diminished renal reserve (GFR 90 Ml/min/1.73m) Interstitial space
Stage 2: Renal Insufficiency (GFR 60 89) Alveolar
Stage 3: Renal Failure (GFR 30 59) Pleural space (pleural effusion)
Stage 4: Uremia (GFR 15 29)
(GFR <15)



Loss of non-excretory renal function Loss of excretory renal function

Phosphate elimination Erythropoietin production Na tubules Excretion of Alteration of Glomerular membrane
(Hyperphosphatemia) reabsorbption nitrogenous waste pH regulation dysfunction

Failure to convert inactive Water retention Accumulation Excretion of HCO Proteinuria
forms of calcium of waste in blood Reabsorption of H
Calcium absorption Metabolic acidosis Decreased plasma
oncotic pressure

Fluid escapes into tissues

ESRD
Anemia
(RBC; pallor,
weakness, dyspnea)
Edema (pitting +3)
Uremia (uremic frost,
uremic fetor n/v,
anorexia, pruritus)
Muscle weakness, malaise
Crackles
Salbutamol; Symbicort;
Augmentin: Furosemide
CHEST X: RAY: Impression:
PNEUMONIA (pleural effusion)


Anorexia & vomiting
Blood transfusion
CBC results:
Hgb: 7.6 8.5
Hct: 23.1 25.7
RBC: 2.5 2.8

Terraferon;
Epoeitin alfa

Ketobest
Plasil, Omeprazole;
NaHCO
CaCO
Furosemide; NaCl
Hemodialysis
Chlorpheniramine
TCO: 19-24 mmol/L
HCO3: 17.3 mmol/L


BUN: 97
Creatinine: 7.0
Edema
Furosemide
Hyponatremia -
Sodium: 121.7

Sevelamer