Renal Flashcards
what does protein in the urine suggest
glomerular filtration failure - should only filter fluid and electrolytes
how is renal function measured
serum urea or serum creatinine
what is seen in renal failure
excretory failure, imbalance of electrolytes, endocrine failure - erythropoeitin, ca metabolism, renin secretion
what is the difference between acute and chronic renal failure
acute - happens suddenly, over hours or days
chronic - gradually lost, over years
what are the 3 causes of renal failure
pre-renal - hypoperfusion of kidney, loss of blood
intra renal - toxins or drugs
post - renal - blockage of urinary duct
what is rhambdomyolysis
large injury damage to muscle, many proteins in blood, blocks the glomerulus, cannot get filtration
what is normally associated with acute renal failure
sudden loss of function - not filtrating anything - build up of fluid - oedema, pulmonary oedema
then get filtration function back - polyuria - before concentrating comes back
how is the cardiac rhythmn affected in acute renal failure
hyperkaelaemia - high potassium and sodium as there is no filtration or electrolyte balance - can alter neuronal activation
what is normally the cause of acute renal failure
pre-renal - infection or injury, hypoperfusion
what is the cause of chronic renal failure
primary - glomerulonephritis, polycystic kidney disease
secondary - diabetes, hypertension
what is glomerulonephritis
normally in children, autoimmune disease attacking glomerulus, proteins leaking through, decrease in plasma proteins - reduced oncotic pressure so increase in oedema
what drugs should be avoided in renal disease
NSAID’s - reduce glomerular blood flow and renin secretion
nephrotoxic drugs - cyclosporin
what are the signs and symptoms of chronic renal disease
symptoms - normally not many, polyuria, nocturia, weak and tired
signs - anaemia, hypertension, renal bone disease
how is chronic renal disease managed
treat infections
remove obstruction - cysts, atheroma, malignancy
reduce hypertension
treat deficiencies - anaemia, calcium and vitamin d
treat diabetes
restrict fluid retention - reduce fluid intake, control sodiuma and potassium intake
what functions of the kidney does renal replacement aim to replace
fluid filtration - excretory function
electrolyte balance
acid base balance
what is contained in the dialysing solution
concentration of electrolytes and fluid we want in our blood to be, allows for passive diffusion of contents from our blood into solution and vice versa
what is involved in haemodialysis
taking blood out your body, anticoagulating it with heparin, then passing it through dialysing solution, before it coming back into your body
why does a patient need to be prepared for haemodialysis
need to prepare an arteriovenous fistula - allows to take blood out of artery and pump it back into vein
what is the dialyser permeable to
hollow tubes, surrounded by dialysing solution, permeable to electrolytes but impermeable to cells and proteins
how is haemodialysis restricting
patient needs to be hooked up every couple days, means they cant go on holiday, also have days they feel good if just had dialysis, feel bad if a day inbetween, restricts what you can eat and drink
how does peritoneal dialysis work
putting fluid in peritoneal sac - completely closed off, small vessels can set up concentration gradient between blood and fluid. can then drain back out of peritoneum
what benefits does peritoneal dialysis have
patient has more control, can do it themselves wherever, not as many ups and downs with feeling if getting it every day, more like real function
what implications does renal treatment have on dentistry
if on haemodialysis - should get treatment the same day as dialysis, feel better
if on peritoneal - doesnt matter as much
if renal transplant - need to be aware of immunosupressants, may require steroid prophylaxis
how do urinary tract infection manifest
perineal bacteria on tract, reduced urinating, normally this washes it away but allows them to colonise. causes inflammation of epithelium
what symptoms are associated with UTI
pain on urinating, dysuria, peeing frequently but little coming out, cloudy urine
how is a UTI diagnosed
mid stream sample - urine should be sterile, the first bit may be contaminated as it washes away, but the middle should be sterile. if sample has cells, proteins or bacteria - infected
how is a UTI treated
normally just increase fluid intake, will wash more away. rarely need antibiotics unless in kidneys
what is renal canaliculi
stones produced in kidney, fine here but then go down ureter, cannot pass them. very painful need to wait for them to pass. can use lithotripsy - ultrasound energy to break them up and allow them to pass
what is prostatitis
inflammation of prostate - enlarges and pushes on urinary tract, restricts space. can be painful to pass urine
what is benign hyperplastic prostate
increased size of prostate gland, reduces space for urethra, pain on peeing or peeing a lot, reduced emptying. happens over several years and is very common. can be put on adreno blocking drugs or surgery
how can a prostatic malignancy be asymptomatic and how is it tested for
if it is in an area not affecting urinating then no symptoms. can do a blood test to check for prostatic specific antigen and then follow up with a scan
how is a prostatic malignancy treated
combination of surgery and radiotherapy. can be given hormone supression drugs to reduce testosterone - thought this can stimulate growth
