In this video I am giving you an easy step-by-step breakdown of the pathophysiology of chronic
kidney disease.
This is one of those med-surg topics you MUST know about in nursing school, because it will
definitely show up on your exams and possibly on the NCLEX.
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the EASIEST way to learn in nursing school.
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Let's dive in.
So chronic kidney disease, in a nutshell, just means that the kidneys are permanently
damaged, and now they can't do their job as well.
The kidneys are in charge of so many things: like filtering the blood and removing waste
products, and keeping a good balance of fluid and electrolytes.
So if the kidneys are damaged, it can lead to some serious problems.
Chronic kidney disease can be caused by things like hypertension, infection, diabetes, or
immune disorders.
Over time, as the kidney disease gets worse, it can lead to end stage renal disease or
renal failure, where the kidneys really can't filter blood at all.
So let's put the pathophysiology into simple steps for you to follow.
I love breaking these tough concepts into easy steps for you because it helps you learn
it so much faster!
Which is what we're all about!
So here’s what's going on during chronic kidney disease.
The first step is there is a trigger that damages the nephrons.
The nephrons are the functional part of the kidney, they do all the work to filter the
blood, so when the nephrons are damaged, it's bad news.
And this leads us to step 2, which is the damaged nephrons can't filter blood as well.
So in step 1, there was a trigger that caused the damage to the nephrons, and so now in
step 2, they can't filter blood like they should.
Now, thankfully, because the body is pretty amazing, the healthy nephrons that aren't
damaged try to compensate for the damaged nephrons.
So they see those damaged one's and they try to help out by increasing the amount of blood
they filter.
This is called the glomerular filtration rate, or GFR.
The GFR is the amount of blood the glomeruli (which are inside the nephrons) can filter
per minute.
So the healthy nephrons will increase their productivity and they will filter more and
more blood to try and compensate.
So that is step number 3 of this process.
As time goes on, more and more nephrons will become damaged.
This will limit blood flow to the kidneys, and the kidneys will trigger a compensatory
response to this lack of blood flow.
This response is called the RAA pathway, and this is step number 4.
With the RAA pathway, the kidneys release an enzyme called renin, and this release of
renin sets off a series of events that ultimately increases the blood pressure in the body.
It's trying to increase the blood flow to the kidneys by increasing the blood pressure.
If you want a deep dive on the RAA system, we have a whole video on that for you to check
out.
Now here's where things get pretty sticky.
Normally, this increase in blood pressure helps get more blood to the kidneys.
But in chronic kidney disease, it actually can decrease blood flow to the kidneys, depending
on what caused it in the first place.
So, for example, if the original cause of the chronic kidney disease was hypertension,
and all that renin just raised the blood pressure even more, well now those arteries leading
to the kidneys are even SMALLER, which will decrease blood flow to the kidneys even more.
And finally, step number 5 is where we start to see the complications, and the major signs
and symptoms of chronic kidney disease.
The key complications you need to know about for nursing school are proteins spilling out
into the urine (called proteinuria), decreased glomerular filtration rate (or GFR), increased
creatinine and urea levels, anemia, and fluids and electrolyte imbalances.
If you're a NursingSOS Member, make sure to log-into your dashboard and find the Signs
and Symptoms video in the Chronic Kidney Disease Series.
In that video, I do a deep dive into why each of these signs and symptoms happens, so be
sure to check that out.
So that is the pathophysiology of CKD.
The nephrons are damaged, and they aren't able to filter as much blood, causing the
RAA system to spring into action, and complications to arise, like protein in the urine, decreased
glomerular filtration rate, and increased urea and creatinine levels.
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