Chronic renal failure pathophysiology

Chronic renal failure Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

• Glomerular Disease

  • Diagnostic Features

    • Red Blood Cell (RBC) casts
    • Proteinuria > 3.5 g/d
    • Systemic disease associated with glomerulopathy
    • Biopsy often needed for definitive diagnosis of nondiabetic glomerular disease
    • Clinical diagnosis diabetic nephropathy

      • Suggested by duration of Diabetes Mellitus (DM)
      • (7-8 years type II, 12-15 years type I),
      • Coexistent retinopathy, progressive
      • Nephrotic range proteinuria

  • Primary Glomerular Disorders

    • Focal glomerulosclerosis
    • Membranous nephropathy
    • Membranoproliferative Glomerulonephritis (MPGN)

  • Secondary Glomerular Disorders

    • Diabetic nephropathy
    • Lupus nephritis
    • Immunoglobulin A (IgA) nephropathy
    • Goodpasture’s syndrome
    • Amyloidosis

• Interstitial Disease or Vascular Disease

  • Diagnostic Features:

    • Bland urinalysis
    • Protein excretion < 2-3 g/d
    • No glomerulopathy-associated systemic disease

  • Interstitial disorders

    • Polycystic kidney disease (PCKD)
    • Analgesic abuse
    • Autoimmune disorders (sarcoidosis, Sjogren’s)
    • Vesicoureteral reflux
    • Nephrolithiasis
    • Obstructive uropathy

  • Vascular disorders

    • Renal artery stenosis (bilateral)
    • Hypertensive nephrosclerosis (can--chronic insterstitial nephritis)
    • Vasculitis
    • Scleroderma