Renal Failure Flashcards by Harry Wheeler

what is polyuria?

patient passing large volumes of urine

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what is dysuria?

pain on passing urine

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what is haematuria?

blood present in the urine

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what is proteinuria?

proteins passing into urine

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what is uraemia?

increased concentrations of urea in the blood

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what is the best way to measure renal function?

look at the estimated glomerular filtration rate

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what are some other ways to measure renal function?

check serum urea
check serum creatine
24hr urine collection

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what are the specifications of renal failure?

loss of excretory function
loss of water and electrolyte balance
loss of acid base balance
loss of endocrine function

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what renal endocrine functions exist in the body?

releases erythropoietin
calcium metabolism
renin secretion

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renal failure can be…?

acute

- chronic

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what are the main differences between acute renal failure and chronic renal failure?

ACUTE:

rapid loss of renal function
usually over hours/days

CHRONIC:

gradual loss of renal function
usually over many years

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what are the different types of renal failure?

pre-renal
renal
post-renal

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what are some causes of pre-renal failure?

interruption of blood flow to the kidneys (severe injury or illness)
sudden and severe drop in blood pressure (shock)

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what are some examples of conditions that may cause pre-renal failure?

shock
renal artery or aorta disease
hypovolaemia

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what causes intrarenal failure?

direct damage to the kidneys by:

inflammation
toxins
drugs
infection
reduced blood supply

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what causes postrenal failure?

obstruction of urine flow due to:

enlarged prostate
kidney stones
bladder tumour
injury

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how does acute renal failure progress?

anuric initially (no urine) with volume overload

- gradually progresses to polyuria

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what are some symptoms of acute renal failure?

ankle oedema or sacral oedema (if bed bound)
pulmonary oedema & breathlessness
raised jugular venous pressure
weight gain

what can acute renal failure lead to the development of?

hyperkalaemia

- uraemia & acidosis

what is hyperkalaemia? what can it cause?

high levels of potassium in the blood

- can lead to cardiac arrest

what type of renal failure does acute renal failure tend to be?

usually a pre-renal cause

chronic renal failure can be divided into two categories, what are these?

primary (rare)

- secondary (common)

what are examples of primary chronic renal failure?

glomerulonephritis

- polycystic kidney disease

what are examples of conditions which may cause secondary chronic renal failure?

diabetes (30%)
hypertension (20%)
drug therapy
vasculitis
renal artery disease/aorta disease

what does glomerulonephritis cause?

- haematuria | - proteinuria

what can glomerulonephritis progress to?

- hypertension | - chronic renal failure

what condition may be a complication of glomerulonephritis?

nephrotic syndrome

what occurs in a patient who suffers from nephrotic syndrome?

- excessive loss of protein in the urine ( >3g in 24hrs) - loss of plasma oncotic pressure - tissue swelling

how does nephrotic syndrome alter the bodies ability to form clots?

HYPERcoagulable state - loss of clotting factors (AT3 deficiency) - dehydration raises other coagulation factor concentrations

what drugs should be avoided in patients with renal disease?

- NSAIDs | - nephrotoxic drugs

why should NSAIDs be avoided in renal failure patients?

- inhibits glomerular blood flow | - causes interstitial nephritis

what are the causes of renal vascular disease?

- reduced blood flow to the kidney | - microangiopathy

what bodily changes may cause reduced blood flow to the kidney?

- atheroma of renal artery/aorta | - hypertension (narrowing of renal artery)

what are examples of conditions that cause immune mediated renal damage?

- multiple myeloma - goodpasture’s syndrome - vaculitits

what is the cause of polycystic kidney disease and how does it present in the body?

- gene mutation - multiple cysts in the renal parenchyma - enlarged kidney - progressive destruction of normal kidney - gradual renal failure

how can you tell if a patient is in end stage renal disease?

when: - eGFR < 15ml/min - creature 800-1000micromol/L

what is the maximum GFR of a patient who has impaired renal function?

60-80

how can chronic renal failure be managed?

- reduce the rate of decline - correct fluid balance - correct deficiencies - removal outflow obstruction - treat infection

what are the signs of chronic renal failure?

- anaemia - hypertension - renal bone disease - low Ca high PO4 - hyperparathyroidism - osteomalacia

what are the symptoms of chronic renal failure?

- polyuria - nocturia - tired & weak - nausea

what are some examples of renal malignancy?

- renal cell carcinoma | - transitional cell carcinoma

if one of your patients has chronic renal failure, how will this affect dental treatment?

must take CARE when prescribing!!! - check all drugs with renal physician - avoid NSAIDs

what oral manifestations does chronic renal failure have?

- delayed tooth eruption - oral ulceration, painful mucosa and tongue due to anaemia - white patches - oral infections (especially post op) - dry mouth and taste disturbance - bleeding tendencies - renal osteodystrophy