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Renal Medicine > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

What is polyuria

A

The frequent passage of large volumes of urine

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2
Q

What is dysuria

A

Discomfort or burning with urination

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3
Q

What is haematuria

A

The presence of blood in urine

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4
Q

What is proteinuria

A

Protein in urine

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5
Q

What is uraemia

A

Kidneys cannot remove urea from the body so waste from urine accumulates in the blood

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6
Q

How can renal function be measured

A

Serum urea
Serum creatinine
eGFR - estimated glomerular filtration rate
24 hour urine collection - best measure

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7
Q

Describe eGFR

A

Modern quick way of looking at renal function calculated from U&Es measurement

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8
Q

What happens during renal failure

A

Loss of renal excretory function
Loss of water and electrolyte balance
Loss of acid base balance
Loss of renal endocrine function

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9
Q

What is controlled by renal endocrine function

A

Erythropoietin
Calcium metabolism
Renin secretion

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10
Q

Describe the different types of renal failure

A

Acute renal failure - rapid loss of renal function usually over hours or days
Chronic renal failure - gradual loss of renal function usually over many years

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11
Q

What are the types of causes of renal failure

A

Pre-renal
Renal
Post-renal

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12
Q

What are the pre-renal causes of renal failure

A

Hypoperfusion of the kidney
Shock
Renal artery or aorta disease
Caused by sudden and severe drop in blood pressure or interruption of blood flow to the kidneys from severe injury or illness

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13
Q

What are the renal causes of renal disease

A 
Chronic disease
Drug damage
Trauma
Rhabdomyolysis
Caused by direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply
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14
Q

What are the post-renal causes of renal failure

A

Renal outflow obstruction

Caused by sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour or injury

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15
Q

What are the signs of acute renal failure

A 
Rapid loss of renal function - creatinine >200umol/L
Anuric initially with volume overload
Ankle oedema or sacral oedema if bed bound
Pulmonary oedema and breathlessness
Raised jugular venous pressure (JVP)
Weight gain
Gradually progresses to polyuria
Development of hypekalaemia (high K+)
Development of uraemia and acidosis
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16
Q

What causes acute renal failure and how is it treated

A

Usually a pre-renal cause
Usually reversible with time
Renal support until recovery - dialysis and nutrition

17
Q

What are the causes of primary renal failure

A

(Rare)
Glomerulonephritis
Polycistic kidney disease

18
Q

What are the causes of secondary renal failure

A 
Diabetes (30%)
Hypertension (20%)
Drug therapy
Vasculitis
Renal artery disease/aorta disease
19
Q

What are the signs of glomerulonephritis

A

Haematuria/proteinuria - otherwise healthy individual

Gradual progression to hypertension and chronic renal failure

20
Q

What is nephrotic syndrome and what are the signs

A

A complication of glomerulonephritis
Excessive loss of protein in the urine - >3g in 24 hours
Loss of plasma oncotic pressure
Oedema
Hypercoagulable state - loss of clotting factors - AT3 deficiency
Dehydration raises other coagulation factor concentrations

21
Q

Which drugs should be avoided in patients with renal disease

A

NSAIDs - inhibit glomerular blood flow and cause interstitial nephritis
Nephrotoxic drugs - cyclosporin

22
Q

How may renal vascular disease present

A

Reduced blood flow to the kidney - atheroma of renal arter/aorta or hypertension of the renal artery
Microangiopathy - immune reaction causing small blood vessel damage, RBC damage and thrombosis - E.Coli 0157

23
Q

What are causes of immune mediated renal damage

A

Multiple myeloma - plasma cell tumour, excess light chain production clogs kidneys - tubular nephritis results
Good pasture’s syndrome - Anti-glomerular basement membrane antibody (anti-gbm)
Vasculitis - SLE and variants

24
Q

What is polycistic disease and what does it cause

A 
Gene mutation (PFD1, 2 or 3)
Can be inherited or spontaneous 
Causes multiple cysts in the renal parenchyma
Enlarged kidney
Progressive destruction of normal kidney
Gradual renal failure
25
Q

When is end stage renal disease diagnosed

A

eGFR <15ml/min

Creatinine 800-1000umol/L

26
Q

What is the normal GFR

A

90+ml/min

27
Q

How is chronic renal failure managed

A

Reduce the rate of decline:
Eliminate nephrotoxic drugs
Control hypertension
Control diabetes
Control vasculitis disease
Use of steroids/other immune suppressant drugs
Correct fluid balance - restrict fluid intake, restrict salt, potassium, protein
Correct deficiencies - anaemia (erythropoietin), calcium (Vit D)
Remove outflow obstruction - renal stones or prostate enlargement
Treat infection - chronic renal system infection

28
Q

What are the signs of chronic renal failure

A 
Anaemia
Hypertension 
Renal bone disease:
Low Ca, high PO4
Hyperthyroidism
Osteomalacia
29
Q

What are the symptoms of chronic renal failure

A 
Insidious - may be few
Polyuria
Nocturnia
Tired and weak
Nausea
30
Q

What is renal replacement therapy

A

Replaces the functions of the kidney

Not a cure

31
Q

What are common renal malignancies

A

Renal cell carcinoma

Transitional cell carcinoma

32
Q

Describe a renal cell carcinoma

A

Renal tubular cell tumour
Abdominal mass and haematuria
Commoner in men and smokers
Hypertension (renin) and polycythaemia (EPO)

33
Q

Describe a transitional cell carcinoma

A

Usually bladder - ureter/kidney possible

Haematuria - often asymptomatic

34
Q

What is important in dentistry and renal disease

A

Check all drugs with renal physician - avoid NSAIDS and some tetracyclines, reduce dose of most others
Growth may be slow in children - tooth eruption may be delayed
Secondary effects of anaemia - oral ulceration, dyaesthesias - painful mucosa and tongue
White patches - uraemia stomatitis
Oral opportunistic infections
Dry mouth and taste disturbance
Bleeding tendencies - platelet dysfunction
Renal osteoid Ts trophy

Renal Medicine (3 decks)

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