Consequences Of Ckd And Eskd Impaired Sodium and Water Homeostasis

Sodium and water balance are primarily regulated by the kidney. Reductions in the number of functioning nephrons decrease glomerular filtration and subsequent reabsorption of sodium and water, leading to edema.

Pathophysiology

Sodium and water balance can be maintained despite wide variations in intake with normal kidney function. The fractional excretion of sodium (FENa) is approximately 1% to 3% with normal kidney function, allowing sodium balance to be maintained with a sodium intake of 120 to 150 mEq (120-150 mmol) per day. Urine osmolality can range from 50-1,200 mOsm/L (50 to 1,200 mmol/L) with normal kidney function, allowing for water balance to be maintained with a wide range of fluid intake. As the number of functioning nephrons decreases, the remaining nephrons increase sodium

excretion and FENa may increase up to 10% to 20%. This produces an osmotic diuresis which impairs the ability of the kidneys to concentrate and dilute urine and the urine becomes fixed at an osmolality close to that of the plasma, approximately 300 mOsm/L (300 mmol/L). The inability of the kidney to concentrate the urine results in nocturia in patients with CKD, usually presenting as early as stage 3 CKD.

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