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BDS2 BAMS - Renal medicine > 1 Renal medicine overview > Flashcards

1 Renal medicine overview Flashcards

1
Q

Key learning points

A
  • difference between acute and chronic renal failure
  • options for a patient with end stage renal disease
  • lifestyle changes needed to live with end stage renal disease and renal replacement
  • effects of renal disease on prescribing medication in dentistry
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2
Q

what does polyuria mean

A

urinate more than normal

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3
Q

what does dysuria mean

A

pain when passing urine

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4
Q

what does haematuria mean

A

blood in urine

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5
Q

what does proteinuria mean

A

protein in urine

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6
Q

what does uraemia mean

A

waste products not being excreted

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7
Q

How can you measure urine function?

A
  1. serum urea levels
  2. serum creatinine levels
  3. 24hr urine collection, creatinine clearance (best measure)
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8
Q

why is it better to measure creatinine levels rather than urea levels

A

urea levels can rise with dehydration

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9
Q

In what ways can renal failure occur

A
  • loss of renal excretory function
  • loss of water and electrolyte balance
  • loss of acid base balance
  • loss of renal endocrine function (erythropoietin, calcium metabolism, renin secretion)
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10
Q

What is the onset of acute renal failure like

A
  • rapid loss of renal function

- usually over hours or days

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11
Q

what is the onset of chronic renal failure like

A
  • gradual loss of renal function

- usually over many years

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12
Q

what are the causes of pre-renal failure

A

Sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness

hypoperfusion of the kidney

  • shock
  • renal artery or aorta disease
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13
Q

what are the causes of intrarenal failure

A

Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply

  • chronic disease
  • drug damage
  • trauma
  • Rhabdomyolysis
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14
Q

what are the causes of post renal failure

A

Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour or injury

  • renal outflow obstruction
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15
Q

What are signs of acute renal function

A
  1. rapid loss of renal function
    - creatinine >200µmol/L
    - no urine initially with volume overload (oedema in ankles, sacral and pulmonary, breathlessness, raised JVP, weight gain)
    - gradually progresses to polyuria
  2. development of Hyperkalaemia (high K+)
    - can lead to cardiac arrest
  3. development of uraemia and acidosis
    - high urea
    - low bicarbonate
    - increased respiratory excretion of CO2
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16
Q

what usually causes acute renal failure

A

a pre-renal cause

17
Q

what’s the prognosis for acute renal failure

A

usually reversible with time

18
Q

how is acute renal failure treated

A

renal support until recover

  • dialysis
  • nutrition
19
Q

what are the most common causes of chronic renal failure (primary and secondary causes)

A

Primary

  • glomerulonephritis
  • polycystic kidney disease

Secondary

  • diabetes
  • hypertension
  • drug therapy
  • vasculitis
  • renal artery disease/ aorta disease
20
Q

What is glomerulonephritis

A
  • glomerulus is inflammed so blood, protein and cells can leak into urine in an other wise healthy individual
  • won’t be producing renin angiotensin properly
  • lead to blood pressure problems
21
Q

how can you get nephrotic syndrome

A

complication of glomerulonephritis

22
Q

what are the signs of nephrotic syndrome

A
  • excessive loss of protein in the urine (3g in 24hrs)
  • loss of plasma oncotic pressure
  • tissue swelling (oedema)
  • hypercoagulable state (loss of clotting factors)
23
Q

what drugs shouldn’t be given to people with renal disease and why

A

NSAIDs

  • inhibit glomerular blood flow
  • cause interstitial nephritis as prostaglandins are inhibited by NSAIDs so will make renal disease worse
24
Q

What causes renal vascular disease

A
  1. reduced blood flow to the kidney
    - atheroma of renal artery/aorta
    - hypertension (narrowing of renal artery)
  2. microangiopathy
    - immune reaction causing small blood vessel damage, RBC damage and thrombosis
25
Q

In what ways can you get immune mediated renal damage

A
  1. multiple myeloma
    - plasma cell tumour
    - excess light chain production ‘clogs’ kidney
  2. goodpasture’s syndrome
    - anti-glomerular basement membrane antibody
  3. vasculitis
    - SLE and varients
26
Q

what causes polycystic kidney disease

A

gene mutation PKD 1,2 or 3

inherited or spontaneous

27
Q

signs of polycystic kidney disease

A

multiple cysts in the renal parenchyma
- enlarged kidney
- progressive destruction of normal kidney
gradual renal failure

28
Q

When is it declared someone has End stage renal disease (ESRD)

A

when:

  • eGFR <15ml/min
  • creatinine 800-1000µmol/L
29
Q

what are the factors for the time taken for someone to have end stage renal disease

A
  • underlying cause

- modifying factors

30
Q

How is end stage renal disease managed?

A
  1. reduce the rate of decline
    - eliminate nephrotoxic drugs
    - control hypertension
    - control diabetes
    - control vasculitic disease
  2. correct fluid balance
    - restrict fluid intake
    - restrict salt, potassium, protein
  3. correct deficiencies
    - anaemia (EPO)
    - calcium (vit D)
  4. remove outflow obstruction
    - renal stones
    - prostate enlargement
  5. treat infection
    - chronic renal system infection
31
Q

Signs of chronic renal failure

A
  • anaemia
  • hypertension
  • renal bone disease (low Ca, high PO4, hyperparathyroidism, osteomalacia)
32
Q

Symptoms of chronic renal failure

A
  • insidious
  • polyuria
  • nocturia
  • tired and weak
  • nausea
33
Q

How does renal replacement therapy help

A

replaces functions of the kidney but NOT a cure

34
Q

What different renal malignancies are there

A
  1. renal cell carcinoma (men, smokers)
    - renal tubular cell tumour
    - abdominal mass and haematuria
    - hypertension (renin) polycythaemia (EPO)
  2. transitional cell carcinoma
    - usually bladder - ureter/ kidney possible
    - haematuria (often asymptomatic)
35
Q

what is important in dentistry when treating patients with renal disease

A
  • few direct oral problems
  • may dictate treatment timing
  • CARE when prescribing (check all drugs with physician, avoid NSAIDs, some tetracyclines, reduce dose of others)
36
Q

What oral impacts can chronic renal failure have

A
  • growth may be slow in children (tooth eruption may be delayed)
  • secondary effects of anaemia (oral ulceration, ‘dysaesthesias’ - painful mucosa and tongue
  • white patches (uraemic stomatitis)
  • oral opportunistic infections
  • dry mouth and taste disturbance (fluid restriction and electrolyte disturbance)
  • bleeding tendencies (platelet dysfunction)
  • renal osteodystrophy (lamina dura lost)

BDS2 BAMS - Renal medicine (3 decks)

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