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Renal Disease Flashcards

1
Q

name 3 urinary tract diseases

A

urinary tract infection
urinary tract obstruction
urinary tract malignancy

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2
Q

what is the most common cause of urinary tract infection?

A

bacterial contamination from the skin around the urethra

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3
Q

how is a urinary tract infection tested?

A

mid stream urine sample to collect the cleanest results

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4
Q

what is the usual bacteria that causes urinary tract infections?

A

e.coli

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5
Q

symptoms of urinary tract infection 4

A

Dysuria - pain when peeing

Increased urinary frequency

Cloudy, offensive smelling urine

Supra-pubic pain

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6
Q

urinary tract infection can lead to what 3 things?

A

cystitis (inflamed bladder), renal infection, prostate infection

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7
Q

what is the treatment for urinary tract infection?

A

Increased fluid intake
Increased peeing
Antibiotics

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8
Q

urinary tract obstruction is caused by what 2 things?

A

renal calculi - stones

prostate disease

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9
Q

when are renal calculi painful?

A

when passing between kidney and bladder

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10
Q

what is the treatment for urinary obstruction caused by renal calculi?

A

Lithotrypsy - Use soundwaves to break up the stone into small fragments so they are easier to pass

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11
Q

how does prostate disease cause urinary tract obstruction?

A

Enlarged prostate reduces size of urethra in men

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12
Q

what causes prostate disease / enlarged prostate? 3

A

prostatitis

benign prostatic hypertrophy

prostatic cancer - adenocarcinoma

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13
Q

what drugs treat benign prostatic hypertrophy? 3

A

A-blocking and anticholinergic drugs to shrink the gland down

Diuretics to flush through the urinary problem

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14
Q

what surgery treats benign prostatic hypertrophy?

A

prostatectomy

  • Transurethral prostatectomy
  • Robot assisted prostatectomy RALP
  • Open prostatectomy
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15
Q

how is prostate cancer screened? 2

A

mpMRI

Prostate specific antigen blood test not recommended due to problems with specificity and sensitivity

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16
Q

what is the treatment for prostate cancer?

A

Surgery - radical prostatectomy

Radiotherapy

Hormone treatment
- anti-androgens and LHRH analogues
- Block hormone-dependant tumour growth -> Shrink it

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17
Q

symptoms of prostate disease 6

A

Slow stream

Hesitancy - difficult to start

Increased frequency of urination

Urgency - limited time between feeling the need to pee and pee starting

Nocturia - peeing at night

Incomplete voiding - > increased UTI risk

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18
Q

define polyuria

A

Large volume of urine

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19
Q

define dysuria

A

pain on passing urine

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20
Q

define haematuria

A

Blood in urine

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21
Q

define proteinuria

A

protein passing into the urine - glomerular disease

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22
Q

define uraemia

A

Increased concentration of urea in the blood

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23
Q

how is renal function measured?

A

Estimated glomerular filtration rate

Serum urea and creatinine

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24
Q

renal failure is a loss of what 4 things

A

excretory function
water and electrolyte balance
acid base balance
renal endocrine function

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25
what renal endocrine functions are lost during renal failure?
Erythropoietin - hormone that stimulates red cell production Calcium metabolism - Role of kidney through hydroxylation of vitamin D precursors Renin secretion - To control salt and water balance
26
define acute renal failure
Rapid loss of renal function, usually over a couple of hours or days
27
is acute renal failure reversible?
yes, usually
28
what happens in acute renal failure to creatinine levels?
rise rapidly >200mol/l
29
what is the cause of acute renal failure usually?
pre-renal cause - problem with blood flow to the kidney
30
acute renal failure is usually caused by lack of blood flow to the kidney After initial injury ?? is produced -> anuria. Because urine is not being lost ? volume is collecting within the body -> ?. As the situation deteriorates ?? and ? will increase and the ?? pressure will be raised. This increase in fluid retention will increase the pt's ? Gradually as the kidneys start to heal there will be progress through to ? this happens as the ability of the kidney to ? the urine returns before the ability of the kidney to ? the urine, therefore a ? volume of ? urine is produced. This will gradually settle as the renal function heals
no urine fluid oedema pulmonary oedema breathlessness jugular venous weight polyuria filter concentrate large dilute
31
acute renal failure can lead to what 3 things?
hyperkalaemia -> cardiac arrest uraemia acidosis
32
what is hyperkamaemia?
(high K+) which can lead to cardiac arrest
33
what is uraemia?
Raised level of urea
34
what is acidosis?
when acid builds up or bicarbonate is low
35
in acute renal failure why is acidosis limited?
there is respiratory compensation for the high acid level in the blood with a raised respiratory rate
36
what is more common acute our chronic renal failure?
chronic
37
what is chronic renal failure?
Gradual loss of renal function, usually over many years
38
what is the cause of chronic renal failure? 5
Most are secondary, not due to the kidney themselves diabetes hypertension drug therapy vasculitis renal artery disease / aortic disease
39
how does diabetes cause chronic renal failure?
damage blood vessels causing them to narrow and be clogged - reduced blood flow to kidneys
40
how does hypertension cause chronic renal failure?
thickened and narrowed blood vessels - reduced blood flow to kidneys
41
how does drug therapy cause chronic renal failure?
direct damage, trigger an immune response, crystallisation, toxic drug metabolites
42
how does vasculitis cause chronic renal failure?
damage glomeruli - tiny blood vessels in the kidney
43
what are the signs of chronic renal failure? 3
Anaemia - as kidneys don’t produce erythropoietin - hormone that stimulate RBC production Hypertension - reduced blood flow to kidneys so produce more renin - retain water and salt Renal bone disease - kidneys cant regulate Ca and PO. When PO high PTH released causing Ca to move from bones to blood
44
what is glomerulonephritis?
Causes damage to glomerulus directly the changes resulting allow cells and proteins to leak into the urine. This will gradually progress leading to hypertension and chronic renal failure
45
what is nephrotic syndrome?
Type of glomerulonephritis with excessive protein loss Side effect is pt loses clotting factors causing a hypercoagulable state
46
what drugs should be avoided if renal disease is apparent?
NSAIDs - avoid as inhibit glomerular blood flow and cause interstitial nephritis Nephrotoxic drugs e.g. cyclosporin
47
what is polycystic kidney disease?
Inherited or spontaneous gene mutation that results in multiple cysts in the renal parenchyma Enlarged kidney, progressive destruction of normal kidney leading to gradual renal failure
48
what is end stage renal disease?
When glomerular function can no longer maintain life
49
what is the EGFR of end stage renal disease?
<15ml/min
50
what is the creatinine level of end stage renal disease?
Creatinine 800-1000mol/L
51
how is chronic renal failure managed? 5
Reduce the rate of decline - eliminate nephrotoxic drugs and control hypertension, diabetes and vasculitic disease Correct fluid balance - restrict fluid intake and restrict salt, potassium and protein Correct deficiencies - anaemia and calcium (vit D) Remove outflow obstruction - renal calculi, prostate enlargement Treat infection
52
name 2 common types of renal malignancy
renal cell carcinoma and transitional cell carcinoma
53
how does renal disease affect dental prescribing? 3
Check with renal physician Avoid NSAIDs and some tetracyclines Reduce dose of most other
54
how does renal disease affect children?
Tooth eruption and growth may be slower
55
oral manifestations of renal disease
Oral ulceration and dysaesthesia (painful mucosa and tongue) - anaemia White patches - uraemic stomatitis Prone to infection - including post-operatively Dry mouth and taste disturbance - fluid restriction and electrolyte disturbance Bleeding tendencies - platelet dysfunction Lamina dura lost and bony radiolucencies - hyperparathyroidism increases osteoclast activity
56
what is haemodialysis?
Blood taken out of the body, put through a dialysis unit and returned to the body
57
what is peritoneal dialysis?
Dialysing solution is introduced into the peritoneal cavity and the inner lining of the peritoneum is used as a dialysis membrane. The dialysing solution can then be taken out having re-equilibrated the concentration of materials
58
what is an advantage of peritoneal dialysis?
Portable allowing pt to have a more normal life and can pick a dialysis routine that suits them
59
dentistry and renal dialysis 3 things
Treat after haemodialysis session Liase with physician on drugs No complex treatment plan
60
what three renal endocrine things need replacing from renal failure?
erythropoietin bone mass maintenance hypertension control
61
how is erythropoietin replaced in renal endocrine replacement?
Replaced by EPO injections to maintain RBC mass
62
how is bone mass maintained in renal endocrine replacement?
Vitamin D and calcium supplementation Osteoporosis prevention programme - bisphosphonates
63
how is hypertension controlled in renal endocrine replacement?
ACE inhibitors to inactivate renin-angiotensin system
64
what is the optimal treatment for end stage renal disease?
renal transplantation
65
in a renal transplantation is the kidney put in the same place as the original one?
no
66
what are the potential problems with renal transplantation?
Acute or chronic rejection Immunosuppression - increase risk of malignancy and infection Osteoporosis risk High cardiovascular mortality
67
dentistry and renal transplant 5
Renal function may reduce with time - check creatinine levels Immune suppression problems - risk of infections, increased risk of caries, perio, cancer Drug interactions and complications § Prednisolone, azathioprine, tacrolimus, cyclosporin Steroid side effects Increased cancer risk

5 Human Diseases (16 decks)

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