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Human Diseases > HD 1 - Patients with chronic renal disease > Flashcards

HD 1 - Patients with chronic renal disease Flashcards

1
Q

Where is Vitamin D and EPO made?

A

Kidneys

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2
Q

What is the GFR in renal function per day and per min?

A

Per day –> 180L

Per min –> 125ml

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3
Q

How many litres of urine passed per day?

A

1.5L

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4
Q

How can you measure renal function?

A

Measure serum creatinine with a blood test

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5
Q

What is the entering and exiting arterioles of the glomerulus?

A

Entering is efferent arteriole and leaving is afferent arteriole

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6
Q

In the kidney was are the structures in the nephron after the glomerulus?

A

Bowmans capsule, proximal convoluted tubules, loop of henle, distal convoluted tubules, collecting duct, urine

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7
Q

What is filtered through the glomerulus from the blood?

A

Water, electrolytes, glucose, amino acids, creatinine

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8
Q

What happens to the number of nephrons when age increases or premature babies, and what condition does this cause in the body?

A

Decreased number, causing high BP later in life

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9
Q

Where in the nephron does the most absorption occue?

A

Proximal convoluted tubule

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10
Q

What occurs in the loop of henle?

A

Absorption of water

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11
Q

What are the 3 glomerular filtration barriers?

A

Filtration slits in epithelial cells of bowmans capsule
Glomerular basement membrane
Fenestrated capillary endothelium

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12
Q

Define GFR?

A

GFR is the sum of filtration rates in all functioning nephrons

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13
Q

How is GFR measured?

A

Creatinine clearance
Plasma creatinine concentration
Estimation Equation e.g. Cockroft - Gault, MDRD

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14
Q

How does creatinine travel through glomerulus?

A

Flows freely

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15
Q

Where is creatinine secreted in the nephron?

A

Secreted by tubules

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16
Q

How does creatinine arise in the body?

A

From metabolism of creatinine in skeletal muscles and in dietary meat intake

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17
Q

Where is 15% of urinary creatine derived?

A

Tubular secretion by proximal convoluted tubule

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18
Q

What is the equation of creatine clearance?

What are the limitations of this?

A

Urine creatinine conc. X Urine vol. / Plasma creatinine conc.

Incomplete urine collection.
Increased creatinine secretion from tubule in renal impairment.

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19
Q

What are the normal values of creatinine clearance in Males and Females per minute?

A

M –> 120 +/- 25 ml/min

F –> 95 +/- 20ml/min

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20
Q

If there is increased creatinine, what happens to the GFR levels? When would this most likely to be found?

A

Large decrease

In kidney injury = Need dialysis

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21
Q

What cases would the GFR be measured?

A

Those at risk of kidney problems, such as diabetes, stroke, ischaemic heart disease, peripheral vascular disease. Pt.s taking diuretics/ACEIs, family history of renal problems.

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22
Q

What is the GFR in stage 1 chronic kidney disease?

A

90+

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23
Q

What is the GFR in stage 2 chronic kidney disease?

A

60-89

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24
Q

What is the GFR in stage 3 chronic kidney disease?

A

30-59

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25
Q

What is the GFR in stage 4 chronic kidney disease?

A

15-29

26
Q

What is the GFR in stage 5 chronic kidney disease?

A

<15

27
Q

What are the symptoms of stage 1 chronic kidney disease? What treatment would be provided?

A

Normal function but urine/structural abnormalities/genetic trait point to kidney disease
Tx: Observe, control BP

28
Q

What are the symptoms of stage 2 chronic kidney disease? What treatment would be provided?

A

Mildly decreased kidney function and other findings point to kidney disease
Tx: Observe, control BP and address risk factors

29
Q

What are the symptoms of stage 3 chronic kidney disease? What treatment would be provided?

A 
Moderately decreased kidney function
Patient asymptomatic 
Creatinine marginally raised
Hypertensive
Decreased EPO, therefore anaemic
Decreased vitamin D, therefore Ca may be low

Tx: Observe, control BP, address risk factors, modify drug doses and avoid nephrotoxins.
Blood thinners/diuretics/phosphate binders

30
Q

What are the symptoms of stage 4 chronic kidney disease? What treatment would be provided?

A

Severely decreased kidney function
Tired, pale, not unwell
Creatinine 250-600umol/L

Tx: Plan for end-stage renal failure
Dietary restriction, phosphate binders, vit. D supplements and EPO
Take antihypertensive drugs and diuretics
Decrease doses for renally excreted drugs

31
Q

What are the symptoms of stage 5 chronic kidney disease? What treatment would be provided?

A 
End-stage kidney failure 
Serum creatinine >700
Pale, tired and unwell
Anorexia, nauseas, vomiting, uraemia factor, itch
Confused 
Fluid retention and oedema

Tx: Dialysis and transplant

32
Q

What are the creatinine and GFR in people with increased muscles?

A

Creatine higher, therefore GFR higher

33
Q

What are the causes of chronic renal failure?

A

Diabetes - most common, and mainly type 2

34
Q

What is the survival rare of type 1 DM patient on dialysis?

A

5 year survival rate in 50%

35
Q

What alterations need to be made when prescribing in chronic renal failure?

A

Altered rate of elimination of renally excreted drugs = may accumulate e.g. opiates
Altered protein binding = reduced binding of acidic drugs such as phenytoin and increased binding of basic drugs e.g. lignocaine
Nephrotoxic drugs may worsen renal function e.g. gentamicin, NSAID’s

36
Q

Define uraemia?

A

Urea levels which build up in kidney disease, stop platelets working and increase bruising

37
Q

What are the effects of uraemia on the body?

A

Prolonged bleeding time
Normal platelet count but disturbed platelet function
Therefore, check not on aspirin or clopidogrel

38
Q

If patient has uraemia in chronic renal failure, how is the bleeding time improved?

A

Dialysis or increased haematocrit (with EPO)

39
Q

What are the effects of chronic renal failure on the body?

A

Severe metabolic acidosis + hyperkalaemia + hypocalcaemia = increase cardiac instability (kidney gets rid of potassium)
Salt and water retention = peripheral and pulmonary oedema
Cramps, tremor, twitches, restless legs & hormonal imbalance

40
Q

What is the treatment programme of patient on dialysis of ESRF (haemodialysis)?

A

In hospital 3x/week for 4hr periods

41
Q

How is dialysis of ESRF (haemodialysis) placed in patient?

A

Via a tunnelled intrajugular neckline or arm arteriovenous fistula (connect A and V)

42
Q

What takes place during dialysis of ESRF (haemodialysis)?

A

Fully anticoagulated with heparin for each treatment

Fluid removal as well as biochemical correction (NB fluid and diet restricted)

43
Q

What happen if haematoma arises in an arteriovenous fistula, and patient needs dialysis?

A

Might render AVF unsuitable for effective dialysis or too painful to use
Check biochemistry – might require dialysis line whilst AVF rested +/- treated

44
Q

What is the vascular access for dialysis is patient has infection risk?

A 
Temporary Line (‘Vascath’) (LHS) - High infection risk 
Tunnelled Lines (‘Tesio’) (RHS) - Cuffs aims to reduce infection
45
Q

What happens to body function if in acidaemia?

What is the treatment?

A

DANGER: impacts cellular and cardiac function
Tx: Na bicarbonate offers a bridge until dialysis available
o NB: Care if fluid overloaded (increased Na+ = increased Extracellular fluid)
o NB: Care if already hypocalcaemic (increased pH = decreased Ca2+)

46
Q

At what point is the body considered to be in acidaemia state?

A

pH <7.2
HCO3- <16mmol/L
Another cause is lactic acidosis/ DKA/ Poisoning

47
Q

Pericardial effusion can occur following pericarditis, what can this lead to?

A

Cardiac tamponade (Beck’s triad)

48
Q

What can decrease risk of pericardial bleeding in dialysis?

A

Avoid anticoagulation

49
Q

What are the advantages and disadvantages of dialysis treatment of ESRF - CAPD (continuous ambulatory peritoneal dialysis)?

A

+ Continuous ambulatory
+ Gentle, effective
+ Good biochemical control
+ No anticoagulation

  • peritonitis
  • weight gain with glucose as osmotic agent
  • peritoneal membrane failure with time
50
Q

What are the complications of uraemia and dialysis?

A
  • Hypotension, cramp
  • Anaemia
  • Vascular calcification
  • Increased risk of heart disease
  • Amyloidosis as a consequence of beta-2-microglobulin accumulation - carpal tunnel, joints
51
Q

Why does infection arise during dialysis and chronic renal failure? How can this be managed?

A

Natural increased risk with dialysis - 20% dialysis deaths
Immunosuppressed due to uraemia and malnutrition
Defective phagocyte function
Managed by: adjusting antibiotic doses

52
Q

Do immunosuppressed/ transplant/ dialysis/ chronic renal failure patients need antibiotic prophylaxis for dental tx, if so what tx?

A

NO, only if also have prosthetic heart valve or other endocarditis risk
• E.g. amoxycillin 3g 1-hour pre procedure or IV Vancomycin and gentamicin for HD pts, clindamycin for tx pts who are penicillin allergic

53
Q

What are the drug treatments for immunosuppression for renal transplants?

A
  • Prednisolone
  • Azathioprine = inhibits purine synthesis and so DNA synthesis = Lymphocytes and neutrophils more sensitive than other proliferating cells
  • MMF or mycophenolate mofetil = more selective inhibition of purine synthesis, blocks proliferating lymphocytes only
54
Q

What are the drug treatments for general transplant immunosuppression?

A
  • Cyclosporin A or Neoral = calcineurin inhibitor which blocks activation of T cells and so of cytokines such as IL-2
  • FK506 or tacrolimus = similar mode of action but more potent
  • Side effect of gum hypertrophy
55
Q

What is the function of sirolimus?

A

Inhibits response to cytokines
Potent non calcineurin inhibiting immunosuppressant
Has similar structure to tacrolimus and binds to cytosolic receptors (immunophilins)

56
Q

Whats another name for sirolimus?

A

Rapamycin

57
Q

What are the side effects of sirolimus?

A

Hyperlipidaemia
Delayed wound healing
Stomatitis

58
Q

What are the main dental risks associated with chronic renal failure?

A

Gum hypertrophy and caries

59
Q

How does oral facial digital syndrome affect males and females?

A

X-linked dominant disorder, lethal in males
Females may have cysts (also liver cysts), indistinguishable from those in autosomal dominant polycystic kidney disease
Both show extra renal manifestations

60
Q

What are the cranio-facial abnormalities and oral manifestation of oral facial digital syndrome?

A

Facial milia –> small bumps (cysts) on skin surface
Cleft palate
Dental abnormalities
Bifid and lobulated tongue

61
Q

What are the limb and skeletal abnormalities of oral facial digital syndrome?

A

Brachydactyly –> shortened fingers and toes
Syndactyly –> 2/more digits fused together
Clinodactyly –> curved digits

Human Diseases (17 decks)

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