Renal Failure Flashcards
what is polyuria?
patient passing large volumes of urine
what is dysuria?
pain on passing urine
what is haematuria?
blood present in the urine
what is proteinuria?
proteins passing into urine
what is uraemia?
increased concentrations of urea in the blood
what is the best way to measure renal function?
look at the estimated glomerular filtration rate
what are some other ways to measure renal function?
- check serum urea
- check serum creatine
- 24hr urine collection
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
what renal endocrine functions exist in the body?
- releases erythropoietin
- calcium metabolism
- renin secretion
renal failure can be…?
- acute
- chronic
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
what are the different types of renal failure?
- pre-renal
- renal
- post-renal
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)
what are some examples of conditions that may cause pre-renal failure?
- shock
- renal artery or aorta disease
- hypovolaemia
what causes intrarenal failure?
direct damage to the kidneys by:
- inflammation
- toxins
- drugs
- infection
- reduced blood supply
what causes postrenal failure?
obstruction of urine flow due to:
- enlarged prostate
- kidney stones
- bladder tumour
- injury
how does acute renal failure progress?
- anuric initially (no urine) with volume overload
- gradually progresses to polyuria
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
