Renal Failure

Question 1

how do you measure renal function?

Answer 1

serum UREA, serum CREATININE, eGFR, 24hr urine collection

Question 2

what is renal failure?

Answer 2

loss of renal excretory function, loss of water and electrolyte balance, loss of acid base balance, loss of renal endocrine function (erythropoietin, calcium metabolism, renin secretion)

Question 3

what is acute renal failure?

Answer 3

rapid loss of renal function usually over hours or days

Question 4

what is chronic renal failure?

Answer 4

gradual loss of renal function usually over many years

Question 5

what are the 3 causes of renal failure?

Answer 5

pre-renal, renal and post renal

Question 6

what is pre-renal failure?

Answer 6

hypoperfusion of the kidney due to shock/renal artery or aorta disease

Question 7

what is renal failure in the renal part?

Answer 7

chronic disease, drug damage, trauma, rhabdomyolysis

Question 8

what is post-renal failure?

Answer 8

renal outflow obstruction

Question 9

what are the signs of acute renal failure?

Answer 9

ankle or sacral oedema, pulmonary oedema and breathlessness, raised jugular venous pressure, weight gain, polyuria with time

Question 10

with acute renal failure what can lead to cardiac arrest?

Answer 10

development of hyperkalaemia (high potassium)

Question 11

what develops from acute renal failure?

Answer 11

hyperkalaemia, uraemia (high urea) and acidosis (low bicarbonate) increased respiratory excretion of CO2

Question 12

what are the two types of chronic renal failure?

Answer 12

primary and secondary

Question 13

what causes primary renal failure?

Answer 13

glomerulonephritis and polycystic kidney disease

Question 14

what causes secondary renal failure?

Answer 14

diabetes, hypertension, drug therapy, vasculitis, renal artery disease/aorta disease

Question 15

what does it mean by saying chronic renal failure is a cycle?

Answer 15

reduced kidney function changes blood pressure through renin release which increases vascular resistance. this changes cardiac function which changes renal function and so on. increasing hypertension makes renal failure worse

Question 16

what do patients with glomerulonephritis present with?

Answer 16

haematuria and proteinuria

Question 17

what do patients with glomerulonephritis gradually progress to?

Answer 17

hypertension and chronic renal failure

Question 18

what is nephrotic syndrome?

Answer 18

a complication of glomerulonephritis

Question 19

what happens with nephrotic syndrome?

Answer 19

excessive loss of protein in the urine, loss of plasma oncotic pressure, tissue swelling, loss of clotting factors

Question 20

what drugs induce renal disease?

Answer 20

NSAIDs and nephrotoxic drugs

Question 21

what do NSAIDs do to renal function

Answer 21

inhibit glomerular blood flow and cause interstitial nephritis

Question 22

what is renal vascular disease?

Answer 22

reduced blood flow to kidney

Question 23

what causes renal vascular disease?

Answer 23

atheroma, hypertension or microangiopathy (immune reaction causing small blood vessel damage)

Question 24

what immune mediation damages renal function?

Answer 24

multiple myeloma, goodpasture’s syndrome and vasculitis

Question 25

what is polycystic kidney disease?

Answer 25

gene mutation causing multiple cysts in the renal parenchyma leading to gradual renal failure

Question 26

when is end stage renal disease?

Answer 26

when eGFR<15ml/min and creatinine 800-1000 umol/L

Question 27

how do you manage chronic renal failure?

Answer 27

reduce the rate of decline and correct fluid balance, correct deficiencies, remove outflow obstruction, treat infection

Question 28

how do you reduce the rate of renal decline?

Answer 28

eliminate neophrotoxic drugs, control hypertension, control diabetes, control vasculitic disease

Question 29

how do you correct fluid balance?

Answer 29

restrict fluid intake and restrict salt, potassium and protein

Question 30

what deficiencies do you need to correct when managing renal failure?

Answer 30

anaemia and calcium

Question 31

what obstructions can be removed to help manage renal failure?

Answer 31

renal stones and prostate enlargement

Question 32

what are the signs of chronic renal failure?

Answer 32

anaemia, hypertension, renal bone disease

Question 33

what are the symptoms of chronic renal failure?

Answer 33

insidious, polyuria, nocturia, tired and weak, nausea

Question 34

what renal malignancies are there?

Answer 34

renal cell carcinoma and transitional cell carcinoma

Question 35

what is a renal cell carcinome?

Answer 35

renal tubular cell tumour, abdominal mass and haematuria present

Question 36

what does a renal cell carcinoma cause?

Answer 36

hypertension and polycythaemia

Question 37

where are transitional cell carcinomas found and what symptoms comes with it?

Answer 37

bladder and haematuria

Question 38

as a dentists what drugs should be avoided in patients with renal disease?

Answer 38

NDSAIDs, tetracyclines

Question 39

what should you be aware of as a dentist?

Answer 39

tooth eruption slow in children, secondary effects of anaemia (oral ulceration, dysaesthesias - pain in mucosa and tongue), white patches, oral opportunistic infections, dry mouth and taste disturbance, bleeding tendencies, renal osteodystrophy