Renal Disease Flashcards
List the functions of the kidneys:
- Urine formation
- NaCl and H2O equilibrium
- acid base balance - H+ and HCO3-
- endocrine functions: produces erythropoetin (stimulates RBC production), Vit D activation, produces renin (important in conversion of angiotensin to angiotensin I)
- excretion functions - excess Na, K, Cl, H, HCO3 and water, drugs and drug metabolites (care prescribing), urea, ammonia, creatine, metabolism waste products
What are the consequences of renal failure?
Excretion and fluid balance failure
- oedema and fluid overload
- high potassium (hyperkalaemia) –> cardiac arrest
- accumulation of waste products (uraemia): malaise, anorexia, immunosuppression, rediced platelet function
- drug metabolism - dangerous accumulation or toxicity
Acid-base balance - acidosis (life-threatening)
Endocrine:
- lack of erythropoetin: anaemia
- lack of Vit D - bone disease if chronic
- high BP so increased risk of CVD
Define:
- polyuria:
- oligouria:
- anuria:
- haematuria:
- proteinuria:
- glycosuria:
- dysuria:
- nocturia:
- uraemia:
- hyperkalaemia:
- dialysis:
- estimated glomerular filtration rate eGFR:
- polyuria: alot of urine
- oligouria: little urine
- anuria: no urine
- haematuria: bleeding
- proteinuria: protein in urine
- glycosuria: glucose
- dysuria: pain passing urine
- nocturia: passing urine in the night
- uraemia: high urea
- hyperkalaemia: high potassium
- dialysis: renal replacement therapy
- estimated glomerular filtration rate eGFR: measure of renal function, normal >60ml/min
How is renal disease investigated?
Urine:
- dipsticks, microscopy, microbiology
Blood:
- electrolytes, eGFR
Imaging:
- plain x-rays, IV urogram, ultrasound, MRI, CT
Tissue:
- biopsy
Give an overview of acute kidney disease/injury:
- rapid onset
- often medically unwell - bleed, haemorrhage, septic shock
- acute precipitants (drugs, septic shock)
- susceptible to renal disease
- often oligouric or total anuria
- often reversible with treatment, may need acute dialysis
Give an overview of chronic kidney disease:
- gradual decline in renal function, several years
- multifactorial causes - diabetes, hypertension, atherosclerosis, reflux, neuropathy, GN, obstruction of renal outflow
- gradually reducing urine output
- treatment aims to slow progression
- plan for end stage disease
List some causes for acute kidney injury:
Treatment?
A mixture of causes is common:
- pre-renal acute precipitants: shock states - sepsis, haemorrhage, cardiogenic
- underlying renal disease - glomerular, vascular, tubular
- post renal obstruction - renal stones, bladder stones, prostatic hypertrophy, compression of ureters
Treatment:
- reverse what is reversible e.g. sepsis, dehydration
- meticulous fluid balance
- may need acute dialysis
- usually improves with hospital care
List some nephrotoxic drugs which may worsen acute kidney injuries:
Often exacerbate pre-existing renal disease
- NSAIDS - avoid prescribing in renal pts or frail/elderly
- ACE inhibitors/angiotensin II blockers
- diuretics
- tetracyclines
- cyclosporin
- aminoglycoside antibiotics
What causes glomerulonephritis?
Glomerulonephritis - inflammation of glomeruli
- SLE
- rheumatoid arthritis
- IgA nephropathy
- infective endocarditis
List some intrinsic renal causes of chronic kidney disease:
Post renal causes?
Intrinsic causes:
- Glomerular disease
- Tubulointerstitial disease
- Vascular
Post renal causes - obstruction to urine outflow
- renal or bladder stones
- ureteric obstruction
- benign or malignant prostatic hypertrophy
List some common effects of chronic kidney disease:
- uraemia, reduced immunity, reduced platelet function, malaise, nausea, itch
- fluid retention and reduced urine outflow: hypertension, oedema
- lack of erythropoetin –> anaemia
- renal osteodystrophy - secondary hyperparathyroidism
How is chronic kidney disease treated?
Avoid further damage:
- control BP/diabetes
- immunosuppression
- avoid/reduce drugs
- treat obstruction
- erythropoetin injections
- correct Vit D deficiency
Specialised care - dialysis/transplant consideration
Give an overview of renal replacement therapy:
What are some transplant problems?
- haemodialysis - 3X a week in hospital
- continuous ambulatory peritoneal dialysis - machine free person directed exchanges of dialysate 4-5 times during the day
- automated peritoneal dialysis - machine does exchanges automatically, usually overnight
Transplant Problems:
- rejection - acute/chronic
- immunosuppression - increased infection/malignancy risk
- higher CVD mortality
What are some oral manifestations of renal disease?
- xerostomia
- taste disturbances
- occasional burning sensation of lips and tongue
- mucosal pallor - anaemia
- mucosal bruising from platelet dysfunction and anticoagulation during haemodyalysis
- renal bone disease: loss of lamina dura, radiolucencies, bone healing post extraction
Dental considerations for dialysis patients:
Transplant patients?
- perform treatment on day after dialysis (avoid Rx on day of dialysis)
- do not perform venepuncture or cannulation in fistula arm
- co-existing DM in many pts - usual cautions
Transplant patients:
- complications of immunosuppression drugs
- complex patients require liasing with renal physicians
Emphasis good OH!
