renal failure Flashcards
what is dysuria?
pain on urination
what is haematuria?
blood in urine
what is proteinuria?
protein in urine
-indicates glomerular disease
how can you measure renal function?
serum urea serum creatinine -general guide to function eGFR -quick, function, reliable 24hr urine collection -creatinine clearance best measure
what is renal failure?
loss of renal excretory function loss of water & electrolyte balance loss of renal endocrine function -erythropoietin -ca metabolism -renin secretion
what is acute renal failure?
rapid loss of renal function
usually hours/days
what is chronic renal failure?
gradual loss of renal function
usually over many years
what are the 3 causes of renal failure?
pre-renal -hypoperfusion of the kidney -shock -renal artery/aorta disease renal -chronic disease, drug damage, trauma, rhabdomyolysis post renal -renal outflow obstruction
describe acute renal failure?
creatinine >200micromol/L anuric initially w/ vol overload -ankle oedema -pulmonary oedema & breathlessness -raised jugular venous pressure -weight gain gradually progresses to polyuria development of hyperkalaemia uraemia & acidosis -high urea -low bicarb -increased resp excretion CO2
what is the cause of acute renal failure?
usually pre-renal
reversible with time
renal support until recover
what is primary chronic renal failure?
glomerulonephritis
polycystic kidney disease
what is secondary chronic renal failure?
common diabetes hypertension drug therapy vasculitis renal artery/aorta disease
what is glomerulonephritis?
haematuria/proteinuria
-cells/proteins leak into urine
otherwise healthy
gradual progression to hypertension & chronic renal failure
what is nephrotic syndrome?
complication of glomerulonephritis -excessive loss of protein in urine -loss of plasma oncotic pressure tissue swelling hypercoagulable state -loss of clotting factors -dehydration raises other coagulation factor conc.
what drugs cannot be used in renal disease?
NSAIDs -inhibit glomerular blood flow -cause interstitial nephritis nephrotoxic drugs -cyclosporin
what is renal vascular disease?
reduced blood flow to the kidney -atheroma of renal artery/aorta -hypertension- narrowing of renal artery microangiopathy -immune reaction causing small b.v damage, RBC damage and thrombosis
what can cause immune mediated renal damage?
multiple myeloma -plasma cell tumour -excess light chain prod. clogs kidney goodpasture's syndrome -anti-glomerular basement membrane antibody vasculitis
what is polycystic kidney disease?
gene mutation -inherited/spontaneous multiple cysts in renal parenchyma -enlarged kidney -progressive destruction of normal kidney -gradual renal failure
how is end stage renal disease measured?
eGFR<15ml/min
creatinine 800-1000micromol/L
what does the time taken to ESRD depend on?
underlying cause
modifying factors
how is chronic renal failure managed?
reduce rate of decline correct fluid balance -restrict fluid, salt, K, protein correct deficiencies -anaemia, Ca remove outflow obstruction -renal stones -prostate enlargement treat infection
how is the rate of decline reduced? (chronic renal failure)
eliminate nephrotoxic drugs control hypertension control diabetes control vasculitic disease -steroids/other immune suppressant drugs
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?
insidious polyuria nocturia tired & weak naeusea
describe renal cell carcinoma
renal tubular cell tumour abdominal mass & haematuria more men, smokers hypertension polycythaemia
describe transitional cell carcinoma
usually bladder
-ureter/kidney possible
haematuria
-often asymptomatic
how should you prescribe to a px with renal disease?
check all drugs w/ renal physician
avoid NSAIDs, some tetracyclines
reduce dose of most drugs
how does chronic renal failure impact dentistry?
growth may be slow in children secondary effects of anaemia -oral ulceration -dysesthesias white patches -uraemic stomatitis dry mouth/taste disturbance bleeding tendencies oral infection renal osteodystrophy
