1) Nephrosclerosis is the hardening of the walls of the arterioles and small arteries as well as a tightening or blocking of the lumina of the blood vessels in the kidneys. Over time, this change in the blood supply will cause the kidneys to become ischemic which will become grounds for the destruction of the renal tissue. The kidneys will also become atrophic which will deteriorate the overall function that they possess. With the kidneys being deprived of the adequate blood supply and decline in health/function, the body will try to compensate for this by increasing the blood pressure in order to get the proper amount of blood to the kidneys. This will all happen in a slow and gradual manner, but by the time a person realizes that there is something wrong, the damage has already been done (Gould & Dyer, 2011).

2) Mr. H. has been experiencing edema and weight gain due to the fact that he has been losing protein in his urine and just the fact that his kidneys are not functioning properly. The loss of protein in the urine causes the concentration of album in the blood to drop as well. A drop in albumin will cause a drop in blood volume in the blood vessels. The kidneys will sense this drop in blood volume and begin to retain salt. Fluid will then start to move into the interstitial spaces in the body, thus causing Mr. H. to become swollen. Another cause of the edema may be due to impaired kidney function and they can’t effectively excrete sodium into the urine. If Mr. H. is ingesting more sodium than he can get rid of, his body will hold on to that can cause him to have salt retention. Mr. H. has experienced weight gain due to all this extra fluid that his body has begun to retain (Cunha, 2008).
3) Mr. H. has most likely been experiencing fatigue due to low hemoglobin and hematocrit levels, hypertension and edema. Having low hemoglobin and hematocrit will lead to anemia. With anemia, a person’s red blood cell count is down and the cells of the body are deprived of oxygen. This will quickly make a person feel exhausted. The fact that Mr. H. has hypertension will account for him feeling tired also. His heart is working extra hard to get the blood throughout his body, which would cause him to feel tired. With Mr. H. having edema and being so swollen, the extra weight that he is carrying around will make him feel exhausted very easily (National Kidney Foundation, 2010).

4) Mr. H. is voiding more frequently due to the fact that his renal function has deteriorated. The kidneys are constantly concentrating urine so that a person only has to void ever so often. When the kidneys no longer have the ability to concentrate effectively, the urine output will increase. Mr. H. will also have very dilute urine because his kidneys are not able to filter out the wastes from his body like they should. If his kidneys are not able to get rid of the wastes via his urine, it will be colorless and odorless (Kidneyabc, n.d.).

5) Mr. H. has high blood pressure because of the nephrosclerosis; the hardening and thickening of the blood vessels. The blood flow to the kidneys has been restricted and the body then tries to balance this out by constricting the blood vessels everywhere. The decline in Mr. H’s kidney function has caused him to become anemic because they no longer produce enough of the hormone called erythropoietin to make a sufficient amount of red blood cells. Renal failure will also cause a person to become iron deficient which is also important in red blood cell production. If Mr. H. has low levels of vitamin B12 and folate on top of the other deficiencies listed above, this will be a recipe for anemia. Acid is filtered through the kidneys and disposed of though the urine. Mr. H. cannot remove the acid properly from his body due to his failing kidneys thus creating a buildup in his system. With Mr. H. having metabolic acidosis, he is now at great risk for developing distal tubular acidosis and proximal renal tubular acidosis (Society of Interventional Radiology, n.d.) (Lanigan, 2010) (Pitchard 2010).

6) The signs that Mr. H. has progressed into uremia or end-stage renal failure are that he is now releasing blood and protein in his urine. He does not feel hungry anymore because food tents to taste bad in the end-stage of renal failure. Uremia will cause headaches and fatigue with the buildup of all the extra fluids and wastes. The high creatinine and urea levels are a good indicator of end-stage renal failure. Low hematocrit, serum sodium and serum specific gravity are all signs that Mr. H. has progressed into the end-stages of the disease (Fresenius, n.d.).

7) Mr. H. is at a higher risk of developing pneumonia because his body is already fighting very hard to keep homeostasis and his immune system will be greatly compromised. The first reason that he may get pneumonia is because of the uremia. This will increase the risk of Mr. H. being susceptible to bacterial infections like pneumonia. Another reason that Mr. H. will be more prone to infection will be his increasing malnutrition as the disease progresses. This will cause his neutrophils to become impaired, thus inviting organisms to thrive. Finally, when Mr. H. does go on dialysis, he will become more vulnerable to infection due to the procedure introducing foreign materials into his body. people with end-stage renal failure are at a much higher risk of contracting bacterial infections like pneumonia, sepsis and urinary tract infections (Sakina & Collins, 2006).

References
Cunha, J. P. (2008). Edema. Retrieved from http://www.medicinenet.com/edema/page5.htm

Fresenius Medical Care. (n.d.). End stage renal disease. Retrieved from http://www.ultracare-dialysis.com/KidneyDisease/EndStageRenalDisease.aspx

Gould, B. E., Dyer R. M. (2011). Pathophysiology for the health professions (4th ed., pp. 456-457). St. Louis, MO: Saunders Elsevier

Kidneyabc. (n.d.). CKD symptoms. Retrieved from http://www.kidneyabc.com/cksymptoms/689.html

Kidneyabc. (n.d.). CKD symptoms. Retrieved from http://www.kidneyabc.com/cksymptoms/732.html
Lanigan, D. (2010). Causes of renal failure and anemia. Retrieved from http://www.livestrong.com/article/109382-causes-renal-failure-anemia/
National Kidney Foundation. (2010). Anemia and chronic kidney disease. Retrieved from http://www.kidney.org/atoz/pdf/anemia.pdf
Pritchard, J. (2010). Common causes of metabolic acidosis. Retrieved from http://www.livestrong.com/article/190517-common-causes-of-metabolic-acidosis/
Sakina, B., Collins, A. J. (2006). Infectious complications of chronic kidney disease. Retrieved from http://home.smh.com/sections/service-procedures/medlib/Pandemic/Pan_Renal/PanRenal_Naqvi_050809.pdf
Society of Interventional Radiology. (n.d.). Interventional radiologists diagnose and treat this silent cause of end-stage renal disease. Retrieved from http://www.sirweb.org/patients/hypertension/