Renal

Question 1

what does protein in the urine suggest

Answer 1

glomerular filtration failure - should only filter fluid and electrolytes

Question 2

how is renal function measured

Answer 2

serum urea or serum creatinine

Question 3

what is seen in renal failure

Answer 3

excretory failure, imbalance of electrolytes, endocrine failure - erythropoeitin, ca metabolism, renin secretion

Question 4

what is the difference between acute and chronic renal failure

Answer 4

acute - happens suddenly, over hours or days

chronic - gradually lost, over years

Question 5

what are the 3 causes of renal failure

Answer 5

pre-renal - hypoperfusion of kidney, loss of blood
intra renal - toxins or drugs
post - renal - blockage of urinary duct

Question 6

what is rhambdomyolysis

Answer 6

large injury damage to muscle, many proteins in blood, blocks the glomerulus, cannot get filtration

Question 7

what is normally associated with acute renal failure

Answer 7

sudden loss of function - not filtrating anything - build up of fluid - oedema, pulmonary oedema
then get filtration function back - polyuria - before concentrating comes back

Question 8

how is the cardiac rhythmn affected in acute renal failure

Answer 8

hyperkaelaemia - high potassium and sodium as there is no filtration or electrolyte balance - can alter neuronal activation

Question 9

what is normally the cause of acute renal failure

Answer 9

pre-renal - infection or injury, hypoperfusion

Question 10

what is the cause of chronic renal failure

Answer 10

primary - glomerulonephritis, polycystic kidney disease

secondary - diabetes, hypertension

Question 11

what is glomerulonephritis

Answer 11

normally in children, autoimmune disease attacking glomerulus, proteins leaking through, decrease in plasma proteins - reduced oncotic pressure so increase in oedema

Question 12

what drugs should be avoided in renal disease

Answer 12

NSAID’s - reduce glomerular blood flow and renin secretion

nephrotoxic drugs - cyclosporin

Question 13

what are the signs and symptoms of chronic renal disease

Answer 13

symptoms - normally not many, polyuria, nocturia, weak and tired
signs - anaemia, hypertension, renal bone disease

Question 14

how is chronic renal disease managed

Answer 14

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

Question 15

what functions of the kidney does renal replacement aim to replace

Answer 15

fluid filtration - excretory function
electrolyte balance
acid base balance

Question 16

what is contained in the dialysing solution

Answer 16

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

Question 17

what is involved in haemodialysis

Answer 17

taking blood out your body, anticoagulating it with heparin, then passing it through dialysing solution, before it coming back into your body

Question 18

why does a patient need to be prepared for haemodialysis

Answer 18

need to prepare an arteriovenous fistula - allows to take blood out of artery and pump it back into vein

Question 19

what is the dialyser permeable to

Answer 19

hollow tubes, surrounded by dialysing solution, permeable to electrolytes but impermeable to cells and proteins

Question 20

how is haemodialysis restricting

Answer 20

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

Question 21

how does peritoneal dialysis work

Answer 21

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

Question 22

what benefits does peritoneal dialysis have

Answer 22

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

Question 23

what implications does renal treatment have on dentistry

Answer 23

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

Question 24

how do urinary tract infection manifest

Answer 24

perineal bacteria on tract, reduced urinating, normally this washes it away but allows them to colonise. causes inflammation of epithelium

Question 25

what symptoms are associated with UTI

Answer 25

pain on urinating, dysuria, peeing frequently but little coming out, cloudy urine

Question 26

how is a UTI diagnosed

Answer 26

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

Question 27

how is a UTI treated

Answer 27

normally just increase fluid intake, will wash more away. rarely need antibiotics unless in kidneys

Question 28

what is renal canaliculi

Answer 28

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

Question 29

what is prostatitis

Answer 29

inflammation of prostate - enlarges and pushes on urinary tract, restricts space. can be painful to pass urine

Question 30

what is benign hyperplastic prostate

Answer 30

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

Question 31

how can a prostatic malignancy be asymptomatic and how is it tested for

Answer 31

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

Question 32

how is a prostatic malignancy treated

Answer 32

combination of surgery and radiotherapy. can be given hormone supression drugs to reduce testosterone - thought this can stimulate growth