Renal Diseases Flashcards
What are the specialised functions of the kidney? (4)
- Excretion of many metabolites and drugs
- Regulation of body fluid and electrolyte balance
- Regulation of acid-base balance
- Endocrine functions
Kidneys receive __% of blood volume per minute
25%
Through what mechanism does the kidney reclaim useful materials such as glucose and amino acids?
Selective reabsorption
In the PCT what controls the active transport of Na+?
Angiotensin II
In the PCT active transport of phosphate is suppressed by what?
PTH
What substances are reabsorbed at the PCT? (4)
- Glucose
- Amino acids
- Uric acid
- Inorganic Salts
Renin-Angiotensin-Aldosterone system
What are 2 sources of Vitamin D? (2)
- Skin exposure to UVB
- Diet supplement
What is calcitriol?
Active form of vitamin D in the body
What are the pre-renal factors of acute renal failure? (4)
- Hypotension
- Renal thrombosis
- Sepsis
- Drugs causing renal shutdown
What are the renal factors of acute renal failure? (4)
- Antibiotics
- Analgesic overdose
- Multiple organ failures most often due to trauma or sepsis
- Interstitial nephritis
What is a post-renal factor of acute renal failure?
Obstructed urine flow
How do you manage acute renal failure?
Dialysis
What may arise from acute renal failure? (3)
- Confusion
- Seizure
- Coma
What is Chronic Kidney Disease characterised by?
Characterised by the presence of kidney damage or reduction in GFR (< 90ml/min) for 3 or more months
What are the five stages of Chronic Kidney Disease?
- Early
- Mild
- Moderate
- Severe
- End-stage
Name some common causes of Chronic Kidney Disease (7)
- Long standing Hypertension
- Diabetes Mellitus
- Chronic pyelonephritis
- Chronic glomerulonephritis
- Polycystic renal disease
- Urinary tract obstruction
- Renal artery stenosis
Name some less common causes of Chronic Kidney Disease (6)
- Systemic Lupus Erythematosus
- Amyloid
- Multiple Myeloma
- Gout
- Lead poisoning
- Long-term use of drugs
When do symptoms of Chronic Kidney Disease start too manifest?
When kidney function has fallen below 25%
List some blood and immune clinical features that may arise from Chronic Kidney Disease (3)
- Anaemia
- Bleeding tendencies
- Lymphopenia (susceptibility to infection)
List some metabolic clinical features that may arise from Chronic Kidney Disease (4)
- Increase in nitrogenous compounds
- Renal osteodystrophy
- Vitamin D deficiency
- Polyuria, Polydipsia, Glycosuria
List some gastrointestinal clinical features that may arise from Chronic Kidney Disease (2)
- Anorexia
- Nausea and vomiting
List some meuromuscular clinical features that may arise from Chronic Kidney Disease (5)
- Headaches
- Confusion
- Sensory disturbances
- Tremors
- Peripheral neuropathy
List some cardiovascular clinical features that may arise from Chronic Kidney Disease (4)
- Hypertension
- Congestive cardiac failure
- Atheroma
- Peripheral vascular disease
List some dermatological clinical features that may arise from Chronic Kidney Disease (3)
- Pruritus (itching skin)
- Bruising
- Infections
How would you investigate Chronic Kidney Disease? (5)
- Urine examination
- Full blood count
- Biochemistry
- Renal ultrasound
- Renal biopsy
What may you see from a full blood count to suggest Chronic Kidney Disease? (2)
- Decrease in RBC (Anaemia)
- Impaired platelet function
What changes to a patients biochemistry may you see when investigating Chronic Kidney Disease? (3)
- Increase in urine and creatine
- Increase in potassium and metabolic acidosis
- Increase in phosphate and PTH
What may you see from an urine examination to suggest Chronic Kidney Disease? (3)
- Red cell casts
- White cell casts
- Urate crystals
For Chronic Kidney Disease how would you treat the symptom of hypertension?
ACE inhibitors
For Chronic Kidney Disease how would you treat the symptom of fluid retention?
Diuretics
For Chronic Kidney Disease how would you treat the symptom of Hyperphosphataemia?
Calcium carbonate
For Chronic Kidney Disease how would you treat the symptom of hypoglycaemia?
Calcium supplements
For Chronic Kidney Disease how would you treat the symptom of metabolic acidosis?
Sodium bicarbonate
What does dialysis help remove?
Removes metabolites and excess water
Name some side effects of dialysis (4)
- Hypoxaemia
- Haemolysis
- Hypotension
- Cramps
What are the 2 types of dialysis?
- Peritoneal dialysis
- Haemodialysis
Which dialysis can be carried out at home?
Peritoneal dialysis
Which dialysis is more effective?
Haemodialysis
How long and how frequent is Haemodialysis carried out?
3 times a week for 3 hours each session
What are some potential complications of Renal transplants? (3)
- Transplant rejection
- Immunosuppression induced infection or malignancy
- Increased risk of ischaemic heart disease
What is the dental relevance of Chronic Kidney Disease? (5)
- Dental treatment is best suited for the day after dialysis
- Ensure careful haemostasis during surgical procedures
- Odontogenic infection should be treated promptly
- Prescription of drugs excreted mainly by the kidney needs to be adjusted post consultation with a renal physician
- Avoid systemic fluorides, aspirin and NSAIDs
What is the dental relevance of renal transplantation? (5)
- Patients taking steroids may need steroid cover for stressful procedures
- Transplant patients on immunosuppressants more susceptible to infection
- Transplant patients must carefully monitored and aggressively treated for infections
- Higher risk of gingival hyperplasia
- Higher risk of tuberculosis
What is Nephrotic Syndrome?
Glomerular damage resulting in classical triad of;
- Massive proteinuria
- Hypoalbuminemia
- Oedema
What are risk factors of What is Nephrotic Syndrome?
Major risk factors are conditions that can damage the kidney e.g. diabetic nephropathy, SLE, Amyloidosis
What are some clinical features of nephrotic syndrome?
- Facial and pedal oedema
- Ascites
- Weight gain
- Fatigue
- Loss of appetite
