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5 Human Diseases > Renal Disease > Flashcards

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
- 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
Q

what renal endocrine functions are lost during renal failure?

A

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

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26
Q

define acute renal failure

A

Rapid loss of renal function, usually over a couple of hours or days

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27
Q

is acute renal failure reversible?

A

yes, usually

28
Q

what happens in acute renal failure to creatinine levels?

A

rise rapidly >200mol/l

29
Q

what is the cause of acute renal failure usually?

A

pre-renal cause - problem with blood flow to the kidney

30
Q

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

A

no urine
fluid
oedema
pulmonary oedema
breathlessness
jugular venous
weight

polyuria
filter
concentrate
large
dilute

31
Q

acute renal failure can lead to what 3 things?

A

hyperkalaemia -> cardiac arrest

uraemia

acidosis

32
Q

what is hyperkamaemia?

A

(high K+) which can lead to cardiac arrest

33
Q

what is uraemia?

A

Raised level of urea

34
Q

what is acidosis?

A

when acid builds up or bicarbonate is low

35
Q

in acute renal failure why is acidosis limited?

A

there is respiratory compensation for the high acid level in the blood with a raised respiratory rate

36
Q

what is more common acute our chronic renal failure?

A

chronic

37
Q

what is chronic renal failure?

A

Gradual loss of renal function, usually over many years

38
Q

what is the cause of chronic renal failure? 5

A

Most are secondary, not due to the kidney themselves

diabetes
hypertension
drug therapy
vasculitis
renal artery disease / aortic disease

39
Q

how does diabetes cause chronic renal failure?

A

damage blood vessels causing them to narrow and be clogged - reduced blood flow to kidneys

40
Q

how does hypertension cause chronic renal failure?

A

thickened and narrowed blood vessels - reduced blood flow to kidneys

41
Q

how does drug therapy cause chronic renal failure?

A

direct damage, trigger an immune response, crystallisation, toxic drug metabolites

42
Q

how does vasculitis cause chronic renal failure?

A

damage glomeruli - tiny blood vessels in the kidney

43
Q

what are the signs of chronic renal failure? 3

A

Anaemia - as kidneys don’t produce erythropoietin - hormone that stimulate RBC production

Hypertension - when kidneys aren’t working properly they 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
Q

what is glomerulonephritis?

A

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
Q

what is nephrotic syndrome?

A

Type of glomerulonephritis with excessive protein loss
Side effect is pt loses clotting factors causing a hypercoagulable state

46
Q

what drugs should be avoided if renal disease is apparent?

A

NSAIDs - avoid as inhibit glomerular blood flow and cause interstitial nephritis

Nephrotoxic drugs e.g. cyclosporin

47
Q

what is polycystic kidney disease?

A

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
Q

what is end stage renal disease?

A

When glomerular function can no longer maintain life

49
Q

what is the EGFR of end stage renal disease?

A

<15ml/min

50
Q

what is the creatinine level of end stage renal disease?

A

Creatinine 800-1000mol/L

51
Q

how is chronic renal failure managed? 5

A

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
Q

name 2 common types of renal malignancy

A

renal cell carcinoma and transitional cell carcinoma

53
Q

how does renal disease affect dental prescribing? 3

A

Check with renal physician

Avoid NSAIDs and some tetracyclines

Reduce dose of most other

54
Q

how does renal disease affect children?

A

Tooth eruption and growth may be slower

55
Q

oral manifestations of renal disease

A

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
Q

what is haemodialysis?

A

Blood taken out of the body, put through a dialysis unit and returned to the body

57
Q

what is peritoneal dialysis?

A

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
Q

what is an advantage of peritoneal dialysis?

A

Portable allowing pt to have a more normal life and can pick a dialysis routine that suits them

59
Q

dentistry and renal dialysis 3 things

A

Treat after haemodialysis session

Liase with physician on drugs

No complex treatment plan

60
Q

what three renal endocrine things need replacing from renal failure?

A

erythropoietin
bone mass maintenance
hypertension control

61
Q

how is erythropoietin replaced in renal endocrine replacement?

A

Replaced by EPO injections to maintain RBC mass

62
Q

how is bone mass maintained in renal endocrine replacement?

A

Vitamin D and calcium supplementation

Osteoporosis prevention programme - bisphosphonates

63
Q

how is hypertension controlled in renal endocrine replacement?

A

ACE inhibitors to inactivate renin-angiotensin system

64
Q

what is the optimal treatment for end stage renal disease?

A

renal transplantation

65
Q

in a renal transplantation is the kidney put in the same place as the original one?

A

no

66
Q

what are the potential problems with renal transplantation?

A

Acute or chronic rejection

Immunosuppression - increase risk of malignancy and infection

Osteoporosis risk

High cardiovascular mortality

67
Q

dentistry and renal transplant 5

A

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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