Kidney disease Flashcards
Which portion of the kidney is highly vascular and where most of the filtration and reabsorbtion of nutrients occurs?
Renal cortex
Which portion of the kidney houses the nephrons?
Renal pyramid/medulla
____% of renal plasma flow is filtered into Bowman’s space
20%
___ is portion of kidney where blood contents first get put into the collecting system
Glomerulus
The _________ gradient forces glomerular filtration.
hydrostatic pressure
What are the 3 autoregulation factors of GFR?
- vasoreactive (myogenic) reflex of afferent arteriole
- tubuloglomerular feedback (TGF)
- angiotensin II-mediated vasoconstriction of the efferent arteriole
(autoregulation factors of GFR)
- causes dilatation or constriction of the afferent arteriole to maintain
stable glomerular pressure in response to variations in systole
vasoreactive (myogenic) reflex of afferent arteriole
(autoregulation factors of GFR)
- causes dilatation or constriction of the afferent arteriole to maintain
stable glomerular pressure in response to solute concentration changes
detected by the macula densa cells in the distal/ascending Loop of
Henle
tubuloglomerular feedback (TGF)
Where does the angiotensin 2-mediated vasoconstriction occur?
Efferent arteriole
\_\_\_\_ function • Water regulation • Electrolyte regulation • Extracellular volume/pressure regulation • Acid-base homeostasis • Endocrine/metabolic oKinins oErythropoietin oPhosphate oVitamin D oRenin • Blood plasma filtration oGlucose and amino acid reabsorption oCalcium and phosphate regulation • Excretion of metabolic waste –nitrogenous, etc. • Urine production • Prostaglandin production
Kidney function
A condition in which the kidneys suddenly can’t filter waste from the blood.
Acute renal failure develops rapidly over a few hours or days. It may be fatal. It’s most
common in those who are critically ill and already hospitalized.
Acute renal failure
Acute Kidney injury
Symptoms decreased urinary output swelling due to fluid retention nausea Fatigue shortness of breath. Sometimes symptoms may be subtle or may not appear at all.
Acute renal failure
What are the 3 causes of acute renal failure
- Pre-renal
- Intrinsic Renal
- Post-renal
Which cause of acute renal failure?
- low blood flow leading to low CO and bp
- Kidney tries to compensate
Prerenal ARF
Which cause of acute renal failure?
- Glomerular
- Vascular
- Ischemia
- Sepsis/infection
- Nephrotoxins
INtrinsic
These drugs are toxic to kidney in improper doses/condtions and cause ______
ACE-I: monopril, captopril, enalapril
ARB: angiotensin receptor blocker, (Diovan, Cozaar,
Benicar);
NSAIDs:Indomethacin
PPI: proton pump inhibitors Prilosec, Prevacid &
Nexium (also linked to stomach cancer)
TTP-HUS, thrombotic thrombocytopenic purpura–
hemolytic-uremic syndrome.
ARF
Which cause of acute renal failure?
-back up from bladder/ bladder obstruction
Postrenal
How do you treat ARF?
Address cause
Fluids
Meds
Dialysis
The following cause \_\_\_\_\_\_: •Chronic Glomerulonephritis •Systemic Lupus Erythematosus •Neoplasms •Polycystic kidney disease •AIDS nephropathy •Diabetic nephropathy
Chronic kidney failure
The following are risk factors for ____:
Age (≥60 years of age) Smoking Obesity HTN :affects endothelial cells • poorly controlled Diabetes • 40-50% of patients with type 2 DM will develop CKD Nephrotoxins/Drugs Infections Low birthweight Chronic Inflammation
What is the value of GFR indicative of chronic kidney disease?
<60 ml/min/1.73^2
What is the value of GFR for end stage renal disease?
<15 ml/min/1.73^2
GFR steadily ______ with age
decreases
How does bone metabolism change in chronic kidney disease?
Overall causes bone loss
Oral manifestations of \_\_\_\_\_\_\_; Xerostomia/dry mouth Halitosis Dysgeusia • Metallic taste Infections • Opportunistic • Periodontal • Odontogenic • Salivary Enamel defects • Children
Chronic kidney disease
- Lack of hydroxylation of 25(OH)D to 1,25(OH)2D which takes place in the kidneys
- Causes lack of Ca+ absorption from intestines
- Stimulates parathormone secretion and Ca+ loss from bone
- Inhibits bone mineralization
Osteodystrophy
\_\_\_\_\_\_\_\_\_ Causes • Loss of lamina dura • Demineralization (“ground-glass”) • Expansile radiolucencies (CGCG, brown tumor) • Wide trabeculae • Loss of cortication • Sclerosis
Osteodystrophy
What is the radiographic bone presentation seen in renal osteodystrophy
Ground glass trabeculation
how are ca and vit d affected in renal osteodystrophy?
Both decreased; Vit D primary issue starting downstream cascade
When should the dental appt be scheduled for pts on dialysis?
Day after dialysis
\_\_\_\_\_\_ (venous access) • Arteriovenous fistula • Ateriovenous graft • Central venous catheter (special, short-term) • Machine filters blood • Heparin is typically used • Every 2-3 days; 3-4 hours/session • Risk of infectious disease –Hep B; Hep C
Hemodialysis
How often is dialysis given?
Every 2-3 days
Where are the AV fistulas and grafts placed for dialysis?
Usually in arm; chest is another location; peritoneum is also used
What is necessary for kidney transplants?
ABO matching
HLA matching
For a kidney transplant pt, how is their immunesystem?
Immunocompromised
Kidney transplant meds for immunosuppression like cyclosporine can cause what 2 oral effects?
- Gingival hyperplasia (cyclosporine)
* Aphthous-like ulcers (mTORi)
What 2 vascular phenomena could occur in renal transplant pt?
Thrombosis and excessive bleeding
Antibiotic prophylaxis IS NOT or IS routinely necessary for peritoneal dialysis
Is not
Antibiotic prophylaxis may be necessary for patients with a _____ graft for dialsysis
synthetic AV
If invasive procedures in patients with stage 4 (severe) or end-stage renal disease → what do you do for abx prophy?
Yes or no?
consult physician about need for antibiotics
Antibiotic prophylaxis is necessary in hemodialysis patients if performing what procedure?
incision and
drainage
What med can be given for pain in renal pts?
Tyelnol; reg doses over longer periods of time
Can ASA be used in high or low doses for renal pts?
Low doses
Are NSAIDs and Opioids good for renal pts?
Nope
What are the 4 ABX that can be routinely used in rental pts wihtout adustment?
oClindamycin
oDoxycycline
oErythromycin
oMetronidazole
Defer elective treatment within first _______ post-transplant
6 months
