renal failure

Question 1

what is dysuria?

Answer 1

pain on urination

Question 2

what is haematuria?

Answer 2

blood in urine

Question 3

what is proteinuria?

Answer 3

protein in urine

-indicates glomerular disease

Question 4

how can you measure renal function?

Answer 4

serum urea
serum creatinine
-general guide to function
eGFR
-quick, function, reliable
24hr urine collection
-creatinine clearance best measure

Question 5

what is renal failure?

Answer 5

loss of renal excretory function
loss of water & electrolyte balance
loss of renal endocrine function
-erythropoietin
-ca metabolism
-renin secretion

Question 6

what is acute renal failure?

Answer 6

rapid loss of renal function

usually hours/days

Question 7

what is chronic renal failure?

Answer 7

gradual loss of renal function

usually over many years

Question 8

what are the 3 causes of renal failure?

Answer 8

pre-renal
-hypoperfusion of the kidney
-shock
-renal artery/aorta disease
renal
-chronic disease, drug damage, trauma, rhabdomyolysis
post renal
-renal outflow obstruction

Question 9

describe acute renal failure?

Answer 9

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

Question 10

what is the cause of acute renal failure?

Answer 10

usually pre-renal
reversible with time
renal support until recover

Question 11

what is primary chronic renal failure?

Answer 11

glomerulonephritis

polycystic kidney disease

Question 12

what is secondary chronic renal failure?

Answer 12

common
diabetes
hypertension
drug therapy
vasculitis
renal artery/aorta disease

Question 13

what is glomerulonephritis?

Answer 13

haematuria/proteinuria
-cells/proteins leak into urine
otherwise healthy
gradual progression to hypertension & chronic renal failure

Question 14

what is nephrotic syndrome?

Answer 14

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.

Question 15

what drugs cannot be used in renal disease?

Answer 15

NSAIDs
-inhibit glomerular blood flow
-cause interstitial nephritis
nephrotoxic drugs
-cyclosporin

Question 16

what is renal vascular disease?

Answer 16

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

Question 17

what can cause immune mediated renal damage?

Answer 17

multiple myeloma
-plasma cell tumour
-excess light chain prod. clogs kidney
goodpasture's syndrome
-anti-glomerular basement membrane antibody
vasculitis

Question 18

what is polycystic kidney disease?

Answer 18

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

Question 19

how is end stage renal disease measured?

Answer 19

eGFR<15ml/min

creatinine 800-1000micromol/L

Question 20

what does the time taken to ESRD depend on?

Answer 20

underlying cause

modifying factors

Question 21

how is chronic renal failure managed?

Answer 21

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

Question 22

how is the rate of decline reduced? (chronic renal failure)

Answer 22

eliminate nephrotoxic drugs
control hypertension
control diabetes
control vasculitic disease
-steroids/other immune suppressant drugs

Question 23

what are the signs of chronic renal failure?

Answer 23

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

Question 24

what are the symptoms of chronic renal failure?

Answer 24

insidious
polyuria
nocturia
tired & weak
naeusea

Question 25

describe renal cell carcinoma

Answer 25

renal tubular cell tumour
abdominal mass & haematuria
more men, smokers
hypertension
polycythaemia

Question 26

describe transitional cell carcinoma

Answer 26

usually bladder
-ureter/kidney possible
haematuria
-often asymptomatic

Question 27

how should you prescribe to a px with renal disease?

Answer 27

check all drugs w/ renal physician
avoid NSAIDs, some tetracyclines
reduce dose of most drugs

Question 28

how does chronic renal failure impact dentistry?

Answer 28

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