Pathophysiology of Renal and Chronic Renal Failure

Running head: PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY1
PART 1:
1.1 Anatomy and physiology of Renal
Kidney is one of the principal organ making up the complete renal system and is
responsible for performing major function like absorption and filtration of water. Kidney is
located within the retroperitoneal area in the parietal peritoneum which is protected by fats
and muscles. The physiology of renal exhibits that it is a bean shaped organ that is highly
vascularized (Chalmers, 2019). Renal organ is bounded by the renal capsule, which is
considered as the tough fibrous coating covering the kidney and is brown in colour. The
interior anatomy of kidney exhibits three different sections namely renal cortex (outer
covering of kidney), renal pelvis and inner medulla (Webster et al., 2017).
Nephrons is considered as the functional and structural unit that make up the complete
renal system. Both the kidney consist of millions of minute filters named as nephrons which
is responsible for regulation of soluble substance and water within the human body and also
filter the blood, reabsorbs the required part and the rest unrequired portion is excreted out in
the form of kidney. Each nephron consists of filter, which is also known as glomerulus and
the tubule. The functional activity of nephron is a two-stage procedure, where glomerulus is
responsible for filtering the blood sand tubule is responsible for filtering and removing of
waste (Scanlon & Sanders, 2018).

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Source: (Scanlon & Sanders, 2018)
1.2 Pathophysiology
Chronic renal failure is also termed as chronic kidney disease (CKD) that includes
reduced renal function and further result in damaged renal failure that varies through mild,
temperate and severe chronic kidney damage. The kidney dysfunction takes place when the
organ is unable to perform ultrafiltration and absorbs water (Bernal et al., 2015). Due to renal
failure, the kidney is unable to maintain the electrolytic homeostasis balance and also fails to
maintain the fluid in the human body. Renal dysfunction is triggered due to loss of renal
tissue function that further leads to medullary hypoxia condition. This condition takes place
when the organ absorb oxygen through thick ascending loop and the counter current
mechanism (Arroyo & Jalan, 2016).
The reduced renal function or activity impedes the ability of kidney to perform its
function such as maintaining electrolytic homeostatic and fluid. The ability of kidney to
concentrate the urine is reduced and is further followed by decreasing the kidney’s ability to
remove excess potassium, phosphates and acid. When the condition of renal failure advances,
the kidney’s ability to concentrate or dilute the urine is completely lost and the urinary
volume fails to respond effectively in response to disparity in water consumption (Felsenfeld,

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Levine & Rodriguez, 2015). The release of high amount of prostaglandin, Adenosine and
nitric oxide associated with cytoskeletal falsification of tubular cells, initiates the loss of
tubular cells polarity that further inhibits the cell to locally adhere. This condition interfere
with the organ by extensively damaging the activity of tubule and hence in extreme condition
result in loss of tubular cells. Due to absence of tubular cells that kidney is unable to reabsorb
water hence, leading in rejecting large quantity of diluted urine and contributing towards
renal dysfunction (Hruska, Seifert & Sugatani, 2015).
Risk factors exhibited by Melanie
The primary risk factors that were exhibited by Melanie includes low glomerular
filtration rate (GFR), high level of serum urea and high blood pressure (hypertension).
According to Nigwekar et al. (2015), the patient suffering from high blood pressure are under
enhanced risk of renal dysfunction as high blood pressure leads to enhanced blood flow that
primarily takes place due to narrowing of arteries. Hence, kidney receives less amount of
blood that signals the organ of dehydration, resulting in low rate of ion and water absorption.
The blood pressure exhibited by Melanie was 190/110mm HG that was therefore considered
as the primary reason of her renal failure (Lazarus et al., 2016). Melanie also exhibited high
amount of urea serum that could be responsible for increasing the level of toxin within the
blood of the patient and might lead to enhanced risk of infection, hence, reducing the
functional activity of kidney. The glomerular filtration rate (GFR) of Melanie was very low
i.e. 10ml/min/1.73m2, whereas the appropriate GFR rate is considered between the range of
60-90ml/min. Low GFR lead to inadequate rate absorption which result in high level of waste
accumulation within the patient body, leading to renal failure (Odutayo et al., 2016).