What is the role of glomerular filtration rate (GFR) in the pathogenesis of azotemia?

Updated: Sep 19, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In addition to accumulation of urea creatinine and other waste products, a substantial reduction in GFR in CKD results in the following:

  • Decreased production of erythropoietin (causing anemia) and vitamin D-3 (causing hypocalcemia, secondary hyperparathyroidism, hyperphosphatemia, and renal osteodystrophy)

  • Reduction in acid, potassium, salt, and water excretion (causing acidosis, hyperkalemia, hypertension, and edema)

  • Platelet dysfunction (leading to increased bleeding tendencies)

The syndrome associated with the signs and symptoms of accumulation of toxic waste products (uremic toxins) is termed uremia and often occurs at a GFR of about 10 mL/min. Some of the uremic toxins (eg, urea, creatinine, phenols, and guanidines) have been identified, but none have been found responsible for all the manifestations of uremia.


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