Kidney disease Flashcards
What are the outer and inner part of the kidneys called?
Outer cortex and inner medulla
What are the 5 main things that the kidney does?
1) Excrete waste
2) Regulating fluid volume and acid/base concentration
3) Maintenance of blood pressure
4) Synthesise erythropoietin
5) Target hormone for parathormone, ADH and aldosterone
How much fluid do we normally filter per minute?
How much of this is reabsorbed?
100ml
99% of it
How many litres of urine do we normally produce per day?
1-2.5L
What are the 4 things that GFR depends on?
- Age
- Blood
- Race
- Gender
Where is the 99% of the blood filtered reabsorbed?
Various parts of the kidney - proximal convoluted tubule, loop of Henle and distal convoluted tubule.
What are the 2 main risk factors for kidney disease?
- Diabetes
- Hypertension
How do we know if a patient is at the end stage of kidney disease, before kidney failure?
GFR < 30
What are the main consequences of kidney disease?
1) Increased CV risk
2) Anaemia and reduced immunity
3) Increased bleeding risk
4) Fluid imbalance
5) Decreased bone health
6) Toxin build up within blood affecting cerebral function
7) Reduced drug excretion so higher levels of drugs in the system
What are the 5 dental implications of kidney disease?
1) Increased periodontal disease
2) Oral signs of anemia (oral pharyngeal web)
3) Bone abnormalities
4) Bleeding tendency increase
5) Care needed with ibuprofen use
Why do we have bone changes in those with kidney disease?
Failure to excrete phosphate and phosphate binds to the free calcium in blood so free calcium level drops.
How are taking these drugs affected, if at all, by kidney disease?
Lignocaine - no alteration
Articaine - no alteration
Amoxycillin - reduce dose if end stage GFR <10
NSAIDS - avoid if end stage or diabetes
Erythromycin - avoid due to any drug interactions
What are the two types of dialysis that can be done?
What GFR are they done at?
Haemodialysis
Peritoneal dialysis
GFR < 10
How is haemodialysis carried out?
- Formation of an IV fistula
- 3 times a week
- Requires a machine
- Usually done in a hospital
- Requires anticoagulation on dialysis to stop blood clotting within the machine
- In the dialysis machine, there is a semi permeable membrane and the toxins diffuse from high conc in blood to low conc in the dialysis fluid.
How does peritoneal dialysis work?
- Inject fluid into the peritoneal space
- No anti-coagulation needed
