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Systemic Disease in Dentistry > Renal Function and Kidney Disease > Flashcards

Renal Function and Kidney Disease Flashcards

1
Q

Describe the basic unit which makes up the kidney

A
  • Nephron made up of glomerulus and tubules
  • Glomeruli filter around 150 litres per day
  • Tubules reabsorb most of this filtrate
  • Urine excretion usually under 3 litres per day
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2
Q

How much of normal cardiac output do kidneys receive?

A

25%

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3
Q

Describe how filtration is achieved in the glomerulus

A
  • Blood pressure progressively reduced from renal artery to glomerular capillaries
  • Glomerular pressure provides hydraulic force for filtration
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4
Q

Describe the % sodium resorption at different points along the tubules

A

PCT - 50-60%
TAL - 25-30%
DCT - 5-10%
Collecting Duct - 1-5%

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5
Q

How is normal renal function usually measured?

A

Assay of serum creatinine (biomarker for kidney function)

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6
Q

What does eGFR stand for?

A

Estimated glomerular filtration rate

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7
Q

Name 4 things which eGFR is based on

A
  1. Age
  2. Gender
  3. Ethnicity
  4. Serum creatinine
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8
Q

What is “normal” GFR?

A

Around 100 mL/min

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9
Q

How many stages are there in chronic kidney disease (CKD)?

A

5

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10
Q

Describe stage 1 CKD

A
  • eGFR = 90+
  • Normal kidney function
  • With urinary structural abnormalities
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11
Q

Describe stage 2 CKD

A
  • eGFR = 60-89
  • Mildly reduced kidney function
  • With urinary structural abnormalities
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12
Q

Describe stage 3 CKD

A
  • eGFR = 30-59
  • Moderately reduced kidney function
  • With or without urinary structural abnormalities
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13
Q

Describe stage 4 CKD

A
  • eGFR = 15-29
  • Severely reduced kidney function
  • With or without urinary structural abnormalities
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14
Q

Describe stage 5 CKD

A
  • eGFR < 15
  • Established renal failure
  • Very severe or dialysis dependent kidney failure
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15
Q

Name 2 reasons kidneys fail

A
  1. Acute Kidney Injury (AKI)

2. Chronic Kidney Disease (CKD)

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16
Q

What is the main issue with acute kidney injury?

A
  • A sudden decrease in kidney function needs urgent assessment as it is usually the setting of another illness
  • Primary problem needs addressed ASAP
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17
Q

Describe the 4 stages in the natural history of AKI

A
  1. Full recover
  2. AKI to CKD
  3. Acute on chronic kidney disease
  4. AKI to ESRD
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18
Q

Name 3 things which normal kidney function depends on

A
  1. Perfusion with adequate pressure and oxygen
  2. Intact nephrons
  3. Free urinary drainage
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19
Q

What is the definition of AKI?

A

A decrease in GFR which occurs within hours to days and is potentially reversible

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20
Q

Name 3 types of AKI

A

Pre-renal - Disordered perfusion of kidney which is structurally normal
Renal - Damage to nephrons often after prolonged pre renal insults
Post-renal - Urinary drainage obstructed

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21
Q

Name 3 causes of pre-renal AKI

A
  1. True Volume Depletion
  2. Hypotension
  3. Oedematous States
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22
Q

Name 2 causes of true volume depletion

A
  1. Blood loss

2. Gastrointestinal losses

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23
Q

Name 2 causes of hypotension

A
  1. Septic shock

2. Cardiogenic shock

24
Q

Name 2 causes of oedematous states

A
  1. Cardiac failure

2. Liver failure

25
Q

Name 2 major causes of acute tubular necrosis

A
  1. Renal ischaemia followed by reperfusion

2. Exposure to nephrotoxins

26
Q

Name 3 nephrotoxins

A
  1. Drugs
  2. Radiocontrast dye
  3. Haem pigments
27
Q

What is the definition of CKD?

A

A decrease in GFR which occurs over months or years and is usually irreversible

28
Q

Name 4 common causes of CKD

A
  1. Diabetic nephropathy
  2. Hypertensive renal vascular disease
  3. Glomerulonephritis
  4. Polycystic kidney disease
29
Q

What is the inheritance pattern of polycystic kidney disease?

A

Autosomal dominant trait

30
Q

What is the most common cause for patients starting dialysis?

A

Diabetes

31
Q

Name 5 major modifiable risk factors of renal disease

A
  1. Diabetes
  2. Hypertension
  3. Smoking
  4. Dyslipidaemia
  5. Cardiac disease
32
Q

Name 3 major unmodifiable risk factors of renal disease

A
  1. Age
  2. Male > Female
  3. Family history
33
Q

What is the principle of dialysis?

A

Chemical bath which contains appropriate molecules and exchange them with the toxins in the blood

34
Q

Name 2 types of chronic dialysis

A
  1. Haemodialysis

2. Peritoneal dialysis

35
Q

Describe haemodialysis

A
  • Usually hospital based
  • Nurse delivered
  • Three times per week
  • Very expensive
  • Restricted to sites with dialysis machines
36
Q

Describe peritoneal dialysis

A
  • Home based
  • Patient performs dialysis
  • Daily administration
  • Uses abdominal cavity
  • Cheaper
37
Q

How is the blood stream prepared for haemodialysis?

A
  • Internal arteriovenous fistula

- Surgical connection of vein and artery in fistula

38
Q

Describe how a kidney transplant is achieved

A
  • Placed ectopically in iliac fossa
  • Original kidneys remain in place
  • Renal vein anastomosis posterior and lateral to artery
39
Q

Describe kidney transplants as an alternative to dialysis

A
  • Better quality of life from patient
  • Much better survival rate for patients
  • Much cheaper than dialysis
  • Life long drug treatment to suppress immune system
40
Q

Describe 4 types of living donors

A

Living related - Parents, siblings etc
Living unrelated - Partner, spouse
Paired donation - Pair doesn’t match so swap with another pair
Paid donation - Illegal

41
Q

What is the most common complication of kidney transplant for dentists?

A

Immunosuppression

42
Q

Name 2 issues with immunosuppression

A
  1. Infections

2. Neoplasia

43
Q

Name 3 examples of infections which are complications of immunosuppression

A
  1. Herpes simplex
  2. Papillomavirus
  3. Candidiasis
44
Q

Name 3 examples of neoplasia which are complications of immunosuppression

A
  1. Squamous cell carcinoma
  2. Basal cell carcinoma
  3. Non-Hodgkin’s lymphoma
45
Q

What is the cause of Non-Hodgkin’s lymphoma?

A

EBV in immunosuppressed patient

46
Q

Describe the presentation of aphthous ulcers

A

Round, yellow-grey ulcers present on oral mucosa

47
Q

Describe the presentation of Herpes Simplex virus

A

Multiple erosions and vesicular lesions are present in the mouth

48
Q

Describe the presentation of Herpes Simplex labialis

A

Grouped vesicles are evident on lower vermilion boarder

49
Q

Describe the presentation of oral candidasis

A

White papules and plaques are present on the palate and tongue

50
Q

Describe the presentation of squamous cell carcinoma on the lip

A

Erythematous, crusted nodule on the lip

51
Q

Describe the presentation of nodular basal cell carcinoma

A

Pearly papule with telangiectasias can be seen

52
Q

Describe the presentation of infiltrative basal cell carcinoma

A

Present as indented, scar like lesions

53
Q

Describe the presentation of Non-Hodgkin’s lymphoma

A

May present as an intra oral tumour

54
Q

What is a common side effect of cyclosporin and calcium channel blockers when used in combination?

A

Gingival enlargement

55
Q

Briefly describe oral diseases commonly found in patients suffering from CKD

A
  • Edentulism
  • Periodontitis
  • Oral pain is common
  • Xerostomia

Systemic Disease in Dentistry (22 decks)

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