Renal Flashcards
what endocrine work do the kidneys do?
produce erythropoietin
activates vitamin D
controls blood pressure via RAAS
what are some renal investigations that can be done by looking at the urine?
dipsticks - glucose/blood/protein/WBC’s
microscopy
microbiology
what are some renal investigations that can be done by looking at the blood?
electrolytes
glomerular filtrate rate
specific tests
what imaging tests can be done for renal?
plain xrays intravenous urogram ultrasound MRI CT
what investigations can be done via looking at the tissue?
renal biopsy
what are some consequences of renal failure?
oedema high potassium - cardiac arrest accumulation of waste products - ureamia drug metabolism acidosis lack of erythropoietin lack of vit d high bp
what are some causes of renal failure?
diabetes high bp artherosclerosis autoimmune - glomerulonephritis cancer - myeloma hypovolaemia
what drugs can cause renal failure by exacerbating pre existing disease?
NSAIDS ACE inhibitors diuretics tetracyclines idiosyncratic reactions - penicillin/NSAIDS
what infections can cause renal failure
recurrent ascending UTI’s
what kind of obstructions can cause renal failure?
prostate
stones
abdominal/pelvic stones
polycystic kidney disease
what are the 2 forms of renal disease?
acute
chronic
what is acute renal failure?
- acute loss of renal function - normal/low absent urine -output
- life threatning - hyperkaleamia/uraemia, fluid retention, hypertension
is acute renal failure reversible?
often, yes
does acute failure happen in healthy kidneys?
usually pre existing disease
how to manage acute failure?
manage underlying cause
treat effects - potassium/fluid removal or replacement
dialysis?
what is chronic renal failure?
gradual progression of renal impairment
end stage renal disease where GFR is 5% of norm
progression depends on underlying cause and modifying factors
what are the most common causes of chronic renal failure?
diabetic retinopathy glomerulonephritis chronic renal infection polscytic renal disease atherosclerosis high bp
what are the effects of chronic renal disease?
uraemia - reduced immunity/platelet function/malaise/nausea/itch
fluid retention - hypertension/odeama
lack of erythropoietin - anaemmia
renal osteodystrophy - secondary hyperparathyroidism
how to treat chronic renal failure?
avoid further damage - control hypertension/diabetes, immunosuppresion, avoid/reduce drugs, treat any obstructions
- correct anaemia - erythropoietin injections
- correct vit d deficiency
types of dialysis?
haemodyalasis
peritoneal dialysis
what are some problems that may rise from transplant?
rejection - acute/chronic
immunosuppresion - increased infection/malignancy risk
high cardiovascular mortality
what is a UTI?
cystitis
increased risk if impaired bladder emptying or low urinary flow rates
e.coli gram negative bacilli
symptoms of UTI and management?
dysurua
pain
antibiotics/increased fluid intake
what may cause a urinary tract obstruction?
prostate
renal calculi
external compression - abdonminal/pelvic malignancies
what oral problems may renal osteodyrstrophy cause?
loss of lamina dura
radiolucencies
problems with bone healing post extraction
why may renal patients have greater bleeding tendencies?
abnormal platelet production, diminished factor 3 and von wilebrands factor
when should you treat a dialysis patient in the dentist and why?
day after dialysis once heparin worn off
what patients may require pep before an invasive procedure?
polycystic kidneys peritoneal dialysis some on haemodialysis renal transplant discuss with renal team
what orofacial manifestations may be seen in renal patients?
osseus lesions - loss of LD, osteoporosis, osteolytic areas, secondary hyperparathyroidism = giant cell lesion, abnormal bone repair
what oral signs may a chronic renal failure patient experience?
dry mouth, halitosis, metallic taste
insidious oral bleeding/purpura, salivary gland swelling
calculus accumulations, oral ulceration and changes b/c anaemia
chronic renal failure in children may cause what orally?
jaw growth retarded tooth eruption delayed malocclusion brownish tooth discolouration prev tetracycline staining low caries rate/less perio disease
