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Year 3 Human Disease > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

ways to measure excretory renal function 4

gfr= glomerular filtration rate

A
  • plasma/ serum creatinine
  • estimated GFR: MDRD formula (sex, age, race, creatinine)
  • creatinine clearance
  • isotope GFR (usually Cr15 EDTA)
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2
Q

problems with serum/plasma creatinine 4

A
  • related to muscle mass (more muscle, more creatinine so normal has big range)
  • may not be elevated above ‘normal’ until 50% GFR lost
  • changes within normal range are significant
  • artefacts: muscle damage, drugs
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3
Q

what kind of creatine measurements are most useful

A

serial

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4
Q

write modified MDRD formula

A

eGFR (ml/min/1.73m2)= 2.107x serum creatinine (umol/l)-1.154 x age -0.203

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5
Q

normal GFR range

A

100-200

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6
Q

define acute kidney injury AKI and outcome

A

rapid loss of renal excretory function (over hours or days rather than weeks)
reversible if underlying condition is treated

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7
Q

define chronic kidney disease CKD

A

slowly progressive loss of excretory renal function. original cause often unknown, usually irreversible (management aimed at slowing progression)

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8
Q

3 causes of AKI

A
  • pre-renal: problem in blood supply to kidney (thrombosis, dec bp)
  • intrarenal: direct damage to kidneys due to inflammation/ toxins/ drugs/ infection/ reduced blood supply
  • post-renal: obstruction to urine flow eg prostate enlargement, kidney stones, bladder, tumour, injury
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9
Q

4 causes of pre renal AKI

A
  • salt and water depletion (diarrhoea, vomiting, diuretics, fever, poor fluid intake)
  • haemorrhage (esp gastrointestinal)
  • hypotension (heart failure, drugs, sepsis, shock)
  • renovascular disease
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10
Q

types of renal AKI and % 3

A

85% tubular necrosis (mostly due to pre renal factors eg low bp)
10% interstitial nephritis
5% glomerulonephritis

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11
Q

how to diagnose kidney disease

A
  • urine dipstick

- renal biopsy (interstitial nephritis, acute glomerulonephritis

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12
Q

8 causes of toxic AKI

A
  • antibiotics eg aminoglycosides, amphotericin
  • radiographic contrast media (inc non-ionic)
  • chemotherapy agents esp cis-platinum
  • rhabdomyolysis
  • intravascular haemolysis
  • tumour lysis
  • solvents (inc ethylene glycol, carbon tetrachloride)
  • hepatorenal syndrome
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13
Q

3 common causes of post renal AKI

A
  • obstruction to outflow from both kidneys or to outflow from a single functional kidney esp prostate in males, cervix in females
  • retroperitoneal fibrosis, neurogenic bladder
  • intra-renal obstruction eg crystals or casts (esp myeloma)
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14
Q

what does prognosis of post renal AKI depend on 2

A
  • underlying condition

- duration of obstruction

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15
Q

causes of chronic kidney disorder 5

A
  • diabetic neuropathy MOST COMMON
  • genetic causes (esp polycystic kidney disease) 10%
  • vascular disease
  • chronic glomerulonephritis
  • chronic urinary outflow obstruction
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16
Q

classification system of chronic kidney disease

A

5 stage according to eGFR

1: normal kidney function with some other evidence of kidney disease
5: eGFR less than 10-15 ml/min ie need for renal replacement

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17
Q

consequences of renal failure 7

A

-accumulation of 6: K+, urea, creatinine, H+, water, PO4
-deficiency of 2: erythropoitin–> anaemia
1 alpha vitamin D3 –> hypocalcaemia, hyper parathyroid hormone, bone disease
-delayed drug excretion
-pulmonary oedema
-xerostomia
-uraemic stomatitis (white/ grey on FOM)
-brown tumour

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18
Q

outcome of K+ accumulation

A

changes polarisation of cells –> large T waves –> cardiac arrythmias –> sudden death

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19
Q

how to control potassium

A

diet (eg less bananas)

20
Q

explain renal bone disease

A

less calcium –> less vit D activation –> non calcified osteoid –> bone resorption

21
Q

4 tx for renal replacement therapy

A
  • dialysis/ transplantation
  • erythropoietin
  • 1 alpha vitamin D
  • sodium bicarbonate
22
Q

normal blood Hb levels

A

130-150g/l

23
Q

how does a haemodyaliser work

A

contains small plastic ‘capillaries’ surrounded by dialysis fluid for filtration

24
Q

explain arterial-venous fistula

A

sew artery to vein –> blood flows in to vein –> dilates vein –> can put needles in to vein for dialysis

25
Q

why are anticoagulants used in dialysis and examples 3

A

stops blood clotting during dialysis

  • heparin for dialysis
  • warfarin for access patency
  • aspirin
26
Q

what does CAPD stand for and how does it work

A

Continuous Ambulatory Peritoneal Dialysis
needle and dialysis in to peritoneum (space between organs) –> fluid exchanged over peritoneal membrane continuously/ 4 times per day

27
Q

6 general consequences of immunosuppression

A
  • infection (correlation with corticosteroid dosage)
  • viral transmission with transplant esp CMV
  • malignancy (esp viral eg lymphoma, skin, cervix. UV exposure and skin type important)
  • hypertension
  • dyslipidaemia
  • osteopaenia
28
Q

2 main causes of gingival hyperplasia

A
  • cyclosporin (immunosuppression)

- calcium blockers (dipines)

29
Q

5 adverse effects of cyclosporin

A
  • nephrotoxicity
  • tremor
  • hirtuism
  • gingival hypertrophy (worsened by nifedipine)
  • interactions (esp macrolides, diltiazem)
30
Q

4 important drug interactions

A
  • cyclosporin and macrolides (erythromycin, clarithromycin)
  • cyclosporin and diltiazem
  • cyclosporin and enzyme inhibitors
  • azatioprine and allopurinol
31
Q

5 considerations for dental care after renal transplantation

A
  • good OH essential
  • gingival hypertrophy (cyclosporin, nifedipine)
  • inc susceptibility to infection
  • antibiotic prophylaxis
  • drug interactions esp erythromycin etc
32
Q

6 normal functions of kidneys

A
  • excretion of salt/ water/ waste products of metabolism (via urine)
  • regulation of acid-base (H+) in tubules
  • regulation of blood pressure (with renin)
  • production of erythropoetin (stimulates RBCs)
  • activation of vit D (1 alpha hydroxylase)
  • excrete water soluble drugs/ metabolites
33
Q

order blood moves around kidney

A

afferent arteriole –> glomerulus -> vasa recta

34
Q

order of nephron system kidneys

A

bowmans capsule –> proximal convoluted tubule –>loop of henle –> distal convoluted tubule –> collecting duct

35
Q

increase in serum creatinine in AKI stage
1
2
3

A

1: 1.5-2
2: 2-3
3: >3 or >354umol/L with acute increase of >44umol/L

36
Q

most common known cause of kidney failure in pts starting renal replacement therapy in UK

A

diabetes

37
Q

% of people in england with diabetes

A

7.4%

38
Q

proportion of people with diabetes who have kidney disease

A

18%-30%

39
Q

% of patients having tx/ dialysis whose kidney disease was due to diabetes

A

14%

40
Q

categories of GFR

A 
G1: normal/ high GFR 
G2:mildly decreased
G3a: mild-mod decreased
G3b: mod-severely decreased
G4: severely decreased
G5: kidney failure
41
Q

what is
a. normal GFR
b/ GFR in kidney failure

A

a. normal GFR: >90ml/min/1.73m2

b. GFR in kidney failure:

42
Q

presentation/ symptoms of chronic kidney disease

A

often asymptomatic until CKD4/5 (GFR

43
Q

3 lab changes of CKD

A

anaemia
disordered bone mineral metabolism
acidosis

44
Q

AKI/ CKD consequeneces:

a. accumulation of (6)
b. deficiency of (2) and consequences
c. delayed (1)

A

a. accumulation of (6): K+, urea, creatinine, H+, water, PO43-
b. deficiency of (2) and consequences: erythropoietin –> anaemia. 1alpha vit D3 –> hypocalcaemia, hyperPTH, bone disease
c. delayed (1): drug excretion

45
Q

what does uraemic stomatitis look like

A

white-grey pseudomembranous lesion on tongue and FOM

Year 3 Human Disease (28 decks)

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