Pathophysiology of Chronic Kidney Failure

The most common causes of Chronic Kidney Failure are diseases or illnesses that damage the kidneys little by little for many years. These include high blood pressure, diabetes mellitus, polycystic kidney disease, obstructions of the urinary tract, glomerulonephritis, certain cancers, autoimmune disorders such as systemic lupus erythematosus, and diseases of the heart or lungs. Using painkilling medications for a long period time may also damage the kidneys and cause chronic renal failure.

What is the Pathophysiology of Chronic Kidney Failure?
1. Regardless of the primary cause of nephron loss, some usually survive or are less severely damaged
2. These nephrons then adapt and enlarge, and clearance per nephron markedly increases.
3. If the initiating process is diffuse, sudden, and severe, such as in some patients with rapidly progressive glomerulonephritis (crescentic glomerulonephritis), acute or subacute renal failure may ensue with the rapid development of ESRD.
4. In most patients, however, disease progression is more gradual and nephron adaptation is possible.
5. Focal glomerulosclerosis develops in these glomeruli, and they eventually become non-functional.
6. At the same time that focal glomerulosclerosis develops, proteinuria markedly increases and systemic hypertension worsens.
7. This process of nephron adaptation has been termed the "final common path."
8. Adapted nephrons enhance the ability of the kidney to postpone uremia, but ultimately the adaptation process leads to the demise of these nephrons.