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CHHD > Renal Diseases (Nephrology) > Flashcards

Renal Diseases (Nephrology) Flashcards

1
Q

What are the specialised function of the kidneys

A
  • Excretion of many metabolites and drugs
  • Regulation of body fluid and electrolyte balance
  • Regulation of acid-base balance
  • Endocrine functions
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2
Q

What does the PCT do in terms of the fluid and electrolytes balance

A
  • Actively reabsorbs glucose, amino acids, uric acid and inorganic salts
  • Active transports of Na+ controlled by angiotensin II
  • Active transport of phosphate suppressed by PTH
  • Water follows by osmosis
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3
Q

What does the Loop of Henle do for the fluid and electrolytes balance

A
  • Water continues to leave by osmosis
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4
Q

What does the DCT do to the fluid and electrolytes balance

A
  • More Na is reabsorbed by active transport and still more water follows by osmosis
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5
Q

What does the Collecting Tubule do to the fluid and electrolytes balance

A

Final adjustment of body Na and water content (ADH and aldosterone)

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6
Q

What are some pre-renal factors of acute renal failure

A
  • Hypotension - haemorrhage/severe burns
  • Renal thrombosis
  • Sepsis
  • Drugs causing renal shutdown (NSAIDs and ACE inhibitors)
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7
Q

What are some renal factors of acute renal failure (ARF)

A
  • Antibiotics - Gentamicin, amphotericin, streptomycin
  • Analgesic overdose - aspirin and other NSAIDs, Paracetamol
  • Multiple organ failures most often due to trauma or sepsis
  • Interstitial nephritis etc.
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8
Q

What are some post-renal factors of acute renal failure (ARF)

A
  • Obstructed urine flow
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9
Q

What is the common management option for acute renal failure (ARF)

A

Dialysis

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10
Q

What is chronic kidney disease (CKD) characterised by

A

The presence of kidney damage or reduction in GFR (< 90ml/min) for 3 or more months

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11
Q

Whats the normal GFR for men and women

A

Male - 130ml/min

Female - 120ml/min

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12
Q

What stages of loss of renal function are there

A 
Early
Mild
Moderate
Severe 
End-stage renal failure
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13
Q

What are some common causes of Chronic Kidney Disease (CKD)

A
  • Long standing hypertension
  • Diabetes Mellitus
  • Chronic Pyelonephritis
  • Chronic glomerulonephritis
  • Polycystic renal disease
  • Urinary tract obstruction
  • Renal artery stenosis
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14
Q

What are some less common causes of Chronic Kidney Disease (CKD)

A
  • Systemic lupus erythematosus
  • Amyloid
  • Multiple myeloma
  • Gout
  • Lead poisoning
  • Long term drug use: analgesics, gold, penicillamine
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15
Q

What are some clinical features of Chronic Kidney Disease (CKD)

A
  • Often symptomless in early stages
  • Symptoms manifest when kidney function has fallen below 25%
  • Blood and immune problems
  • Metabolic problems
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16
Q

What blood and immune related symptoms of CKD are there

A
  • Anaemia - toxic suppression of bone marrow/ decreased erythropoietin
  • Purpura/bleeding tendency - abnormal platelet production/defective vWF, decreased thromboxane
  • Lymphopenia - susceptibility to infections
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17
Q

What metabolic symptoms of CKD are there

A
  • Increased nitrogenous compounds (azotaemia/uraemia)
  • Renal osteodystrophy - Phosphate retention -> decreased plasma calcium -> increased pTH activity
  • Deficiency of active vitamin D
  • Polyuria, Polydipsia, Glycosuria
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18
Q

What are some Gastrointestinal clinical features of CKD

A
  • Anorexia

- Nausea and vomiting

19
Q

What are some Neuromuscular clinical features of CKD

A
  • Headaches
  • Confusion
  • Sensory disturbances
  • Tremors
  • Peripheral neuropathy
20
Q

What are some Cardiovascular clinical features of CKD

A
  • Hypertension
  • Congestive cardiac failure
  • Atheroma
  • Peripheral vascular disease
21
Q

What are some Dermatological clinical features of CKD

A
  • Pruritus
  • Bruising
  • Infections
22
Q

What investigations can be carried out to diagnose CKD

A
  • Urine examination - red/white cell casts, irate crystals
    FBC:
  • Decreased RBC - anaemia,
  • Impaired platelet function -> increased bleeding time
    Biochemistry:
  • Increased urea and creatinine
  • Increased potassium and metabolic acidosis
  • Increased phosphate -> decreased calcium -> increased PTH
  • Renal ultrasound - renal size? Renal obstruction?
  • Renal biopsy
23
Q

What general management methods are there for CKD - basically things that solve the symptoms

A
  • Anaemia: erythropoietin
  • Hypertension: ACE inhibitors e.g. captopril
  • Fluid retention: Diuretics
  • Hyperphosphataemia: Calcium carbonate
  • Hypocalcaemia: calcium supplements/Vitamin D3
  • Metabolic acidosis: sodium bicarbonate
  • High cardiovascular risk: aspirin, statins, smoking cessation
24
Q

What is the treatment goal of CKD

A

To slow down or halt disease progression to end-stage renal failure

25
Q

What analgesics are usually safe for CKD patients and what are best avoided in CKD patients

A

Safe - Paracetamol

Avoid - Pethidine, Tramadol

26
Q

What anaesthetics are usually safe for CKD patients and what are best avoided in CKD patients

A

Safe - Lidocaine

Avoid - NA but prilocaine and articaine is safe but not as safe as lidocaine

27
Q

What anticonvulsants and sedatives are usually safe for CKD patients and what are best avoided in CKD patients

A

Safe - Diazepam, Midazolam

Less Safe - Carbamazepine, Lamotrigine, Gabapentine

28
Q

What does renal dialysis do and when is it used

A

Removes metabolites and excess water

Used mostly in end stage renal failure

29
Q

What adverse effects can renal dialysis cause

A

Due to too rapid or excessive fluid removal - dialysis hangover:

  • Hypoxaemia, Haemolysis and hypotension
  • Cramps, febrile reaction and cardiac arrhythmias
30
Q

What long term adverse effects can renal dialysis cause

A
  • Ischaemic heart disease
  • Aortic valve calcification
  • Dialysis-related neuropathies
31
Q

What are the 2 main types of renal dialysis

A
  • Peritoneal dialysis

- Haemodialysis

32
Q

Describe peritoneal dialysis

A
  • Peritoneal membrane acts as natural semi-permeable membrane
  • Less efficient than haemodialysis but can be carried out more frequently
  • Relatively easy and can be done at home
  • Can be travelled with (continuous ambulatory peritoneal dialysis)
33
Q

Describe Haemodialysis

A
  • Vascular access for introduction of infusion lines (arteriovenous fistula)
  • Patient dialysed 3 times a week for 3 hours each session
34
Q

In which patients is renal replacement therapy the treatment of choice

A
  • Children and patients with diabetic nephropathy
35
Q

What complications arise with renal replacement therapy

A
  • Transplant rejection
  • Immunosuppression induced infection or malignancy
  • Increased risk of ischaemic heart disease
36
Q

What is the dental relevance of CKD

A
  • Dental treatment suited for day after dialysis (heparin effect worn off and for maximal benefit from dialysis)
  • Ensure careful haemostasis during surgical procedures
  • Haemodialysis can predispose to blood-borne viruses
  • Avoid systemic fluorides
  • Avoid aspirin and NSAIDs
  • Drugs excreted mainly bye diner need to be adjusted post consultation with a renal physician
    Renal osteodystrophy:
  • Loss of lamina dura on intraoral radiographs
  • Brown tumours on gingiva
  • Osteomalacia
    Avoid arteriovenous fistulas arm for intravenous cannulation and venipuncture to minimise risk of:
  • fistula infection
  • thrombophlebitis
37
Q

What is the dental relevance of renal transplantation

A
  • Patients taking steroids may need steroid cover for stressful
  • Transplant patients on immunosuppressants more susceptible to infection
  • Transplant patients must be carefully monitored and aggressively treated for infections
  • Cyclosporine - increased risk of gingival hyperplasia
  • Increased risk of tuberculosis
38
Q

What is nephrotic syndrome

A

Glomerular damage resulting in classical triad of:
- Massive proteinuria
- Hypoalbuminaemia
- Oedema
Severe hyperlipidaemia is also often present

39
Q

What are some of the major risk factors of nephrotic syndrome

A

Conditions that can damage the kidney e.g. diabetic nephropathy, SLE, amyloidosis

40
Q

Name some medication and infection related risk factors for nephrotic syndrome

A 
Medications:
- NSAIDs
- Penicillamine
- anti-TNF
- Gold
Infections:
- HIV
- Hepatitis B and C
- Malaria
41
Q

What are the clinical features of nephrotic syndrome

A
  • Facial and pedal oedema, ascites, and weight gain due to fluid retention
  • Poor nutrition
  • Loss of appetite
  • Fatigue
  • Loss of appetite
42
Q

What is the dental relevance of nephrotic syndrome

A
  • High blood pressure
  • Susceptibility to infection due to loss of IgG in urine
  • Loss of cholecalciferol binding protein -> vitamin D def.
  • Loss of antithrombin III and increased clotting factors -> hypercoagulability -> thrombosis
  • Can lead to acute kidney injury or CKD
  • Long term corticosteroid therapy is also a problem
43
Q

How do you diagnose nephrotic syndrome

A
  • Urinalysis - hyperproteinuria
  • Blood test - hypoalbuminemia, hypoproteinaemia, Urea and creatinine for kidney function
  • Kidney needle biopsy
44
Q

What treatment options are there for nephrotic syndrome

A
  • Blood pressure meds - ACE inhibitors and ARBS to decrease BP and protein loss in urine
  • Diuretics to control oedema
  • Statins to lower cholesterol
  • Anticoagulants to prevent clots
  • Immunosuppressants to decrease the inflammation that accompanies some of the conditions that can cause nephrotic syndrome

CHHD (27 decks)

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